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in  2010  with  funding  from 

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THE  HUMAN  FOOT 

ANATOMY,  DEFORMITIES 
AND  TREATMENT 


A   VOLUME    CONTAINING   A    COMPLETE   AND    COMPREHENSIVE  DESCRIPTION   OF 
THE    ANATOMY    OF    THE    FOOT.       NORMAL    AND    ABNORMAL    CONDITIONS, 
DEFORMITIES  OF  THE  FOOT,  THEIR  CAUSE  AND  MECHANICAL  TREAT- 
MENT.        SPECIAL      CHAPTERS      ON      SHOE     FITTING     AND     ITS 
ALLIED     BRANCHES,     INCLUDING     HISTORICAL     FOOTWEAR. 


A  TEXT  BOOK  FOR  THE  STUDENT 
AND  PRACTITIONER 

BY 

DR.  WILLIAM  M.   SCHOLL 


4~ 


PUBLISHED   BY   THE 

FOOT  SPECIALIST  PUBLISHING  CO. 

CHICAGO,   U.  S.  A. 


Copyright  1915 

BY 

DR.  WILLIAM  M.  SCHOLL 


CONTENTS 


Preface 7 

Introduction   9 

CHAPTER    I 
The  Bones 11 

Bones  of  the  Human  Body — Bones  of  the  Foot. 

CHAPTER    II 
The  Tarsus 18 

The  Os  Calcis  or  Heel  Bone — The  Astragalus  Bone — The 
Scaphoid  Bone — The  Cuboid  Bone — Internal  Cuneiform 
Bone — Middle  Cuneiform  Bone — External  Cuneiform  Bone. 

CHAPTER    III 
The  Metatarsals  and  the  Phalanges 21 

First  Metatarsal  Bone — Second  Metatarsal  Bone — Third 
Metatarsal  Bone — Fourth  Metatarsal  Bone — Fifth  Meta- 
tarsal Bone — The  Phalanges  or  Bones  of  the  Toes — The 
Tibia — The  Fibula. 

CHAPTER    IV 

Arches  of  the  Foot 25 

Inner  Longitudinal  Arch — Outer  Longitudinal  Arch — 
Transverse  or  Anterior  Arch. 

CHAPTER    V 
Soft  Structures  of  the  Foot 29 

Ligaments — Tendons — Muscles — Arteries — Veins — Nerves. 

CHAPTER    VI 
The  Ligaments   33 

Tibio-Fibular  Ligaments — The  Inferior  Tibio-Fibular  Liga- 
ments— Ligaments  of  the  Ankle  Joint — Ligaments  of  the 
Tarsus — Metatarso-Phalangeal  Ligaments. 

CHAPTER    VII 
Muscles  and  Tendons  of  the  Leg 43 

Extensor  Muscles  of  the  Leg — Anterior  Group — Posterior 
Group — Fibular  Group. 

3 


4  THE    HUMAN    FOOT 

CHAPTER    VIII 

Muscles  and  Tendons  of  the  Foot 54 

Dorsal   Region — Plantar  Region. 

CHAPTER    IX 

The  Arteries  of  the   Foot 66 

The  Dorsalis  Pedis  Artery — The  Posterior  Tibial  Artery — 
The  Internal  Plantar  Artery — The  External  Plantar  Artery. 
CHAPTER    X 

The  Veins  of  the  Leg  and  Foot 77 

CHAPTER   XI 

The  Nerves  of  the  Leg  and  Foot 81 

CHAPTER    XII 

The  Skin  and  Nails . '. . .     88 

Appendages  of  the  Skin — General  Review. 
CHAPTER    XIII 

Comparative   Anatomy    91 

CHAPTER    XIV 

Physiology    97 

The  Functions  of  the  Foot — Movements. 
CHAPTER    XV 

Mechanical  Consideration  of  the  Human  Foot 102 

CHAPTER    XVI 

Examinations    108 

Examination  of  the  Foot — Palpation — Pain. 
CHAPTER    XVII 

Weakened   Foot    117 

Weak   Flexible   Foot — Acute   Weakened   Foot. 
CHAPTER    XVIII 

Fiat-Foot— Broken-Do wn  Arch    125 

Acquired  Fiat-Foot — Diagnosis — Causes — Congenital  Fiat- 
Foot — Traumatic  Fiat-Foot. 

CHAPTER    XIX 

Treatment  of  Flat- Foot    142 

CHAPTER    XX 

Metatarsalgia — Morton's  Toe    153 

CHAPTER    XXI 

Method  of  Fitting  Arch  Supports 168 

How  to  Make  Secondary  Adjustment — Crystallization   of 
Metals  from  which  Arch  Supports  are  Made. 


CONTENTS  5 

CHAPTER    XXII 
Hallux  Valgus  and   Bunion 188 

Felt  Padding — Treatment  of  Bunion. 
CHAPTER    XXIII 
Hallux  Rigidus  or  Painful  Great  Toe — Hallux  Varus  or  Pigeon 

Toe   201 

CHAPTER    XXIV 

Painful  Heel 204 

CHAPTER    XXV 

Hammer  Toe  208 

Overlapping  Toes. 

CHAPTER    XXVI 

Weak  Ankle — Sprained  Ankle — Tubercular  Ankle 212 

CHAPTER    XXVII 

Talipes  or  Club-Foot    215 

Talipes  Equinus — Talipes  Varus — Talipes  Valgus — Talipes 
Calcaneus. 

CHAPTER    XXVIII 

Pes  Cavus — Hump-Foot — Hollow  Claw-Foot 224 

CHAPTER    XXIX 

Knock- Knee — Bow-Legs — Deformities  of  the  Knee 227 

Accidents  to  the  Patella  and  its  Ligaments. 
CHAPTER    XXX 

Rheumatism — Gout — Other  Joint  Affections 235 

Joint  Affections  Simulating  Rheumatism — Gonorrheal  In- 
fection of  the  Foot. 

CHAPTER    XXXI 

Diseases  Affecting  the  Feet 240 

Myasthenia  (Intermittent  Limping) — Syphilis — Raynaud's 
Disease — Rickets — Varicose   Veins — Ankylosis. 
CHAPTER    XXXII 

Diseases  of  the  Feet 245 

Verruca  or  Wart — Supernumerary  Toes  (Polydactylism)  — 
Webbed  Fingers  and  Toes — Perforating  Ulcer  of  the  Foot — 
Chilblains  (Pernio) — Frost  Bite — Hyperidrosis  or  Exces- 
sive Perspiration — Anhidrosis  or  Scanty  Perspiration — 
Bromidrosis  or  Fetid  Perspiration — Eczema — Syphilis — 
Plantar  Neuralgia — Osteoma — Blister. 
CHAPTER  XXXIII 
Fractures  Affecting  the  Feet 253 


6  THE    HUMAN    FOOT 

CHAPTER    XXXIV 
Dislocations  Affecting  the  Feet 264 

Anatomy — Sub-Astragaloid  Dislocations — Dislocations  of 
the  Tarsal  and  Metatarsal  Bones — Dislocations  of  the 
Metatarsal  Bones  from  the  Tarsus  and  from  One  Another — 
Dislocations  of  the  Toes. 

CHAPTER    XXXV 

Corns  (Cornu,  Horn)    274 

Hard  Corns — Soft  Corns — Suppurated  Corns — Nervo-Vas- 
cular  Corns — Vascular  Corns. 

CHAPTER    XXXVI 

Callosities — Callous    285 

CHAPTER    XXXVII 

Ingrowing  Toe-Nail 289 

Other  Abnormal  Nail  Conditions. 

CHAPTER   XXXVIII 

Skiagraphy   '. 293 

CHAPTER    XXXIX 

History  of  Footwear   297 

Footwear  of  the  Ancients  B.  C.  53-A.  D.  450 — Footwear 
of  the  Greeks  and  Romans — Footwear  of  Anglo-Saxons — 
Anglo-Norman  Footwear  1060-1200  A.  D. — Shoes  Worn 
in  the  Thirteenth  Century — Shoes  Worn  in  the  Fourteenth 
Century — Shoes  Worn  in  the  Fifteenth  Century — Tudor 
Period,  Sixteenth  Century — Stuart  Period  of  the  Seven- 
teenth Century. 

CHAPTER    XL 

Footwear  and  Fitting  of  Shoes 318 

Method  of  Measuring  the  Foot  for  Fitting  Ready-to-Wear 
Shoes — Summary. 

CHAPTER    XLI 

Hosiery    334 

CHAPTER    XLTI 

Care  of  the  Feet 341 

CHAPTER    XLIII 

Method  of  Making  Plaster  of  Paris  Cast  of  the  Foot 343 

To  Take  Plantar  Impression — To  Take  a  Plaster  Cast  of 
the  Entire  Foot  Above  the  Ankle — Method  of  Taking 
Cast   of   Bunion   or   Enlarged   Toe   Joint. 

Index  to  Illustrations 359 

Index  to  Subjects 367 


PREFACE 


IN  presenting  this  volume,  probably  the  first  of  its  kind  ever  pub- 
lished, I  do  so  only  after  numerous  requests  from  the  students 
and  profession  desiring-  to  become  more  efficient  in  the  care  and 
covering  of  the  human  foot.  Great  care  and  every  consideration  have 
been  taken,  with  a  purpose  to  convey  the  fundamentals  in  a  language 
thoroughly  understood  by  the  layman  as  well  as  the  practitioner. 

The  anatomy  of  the  foot,  a  knowledge  of  which  I  consider  a 
valuable  asset  to  those  interested  in  these  branches,  is  written  in  an 
elementary  manner,  and  profuse  with  illustrations  that  it  may  be 
readily  understood  by  all.  I  have  embodied  considerable  informa- 
tion of  the  utmost  value  to  the  shoe  man,  chiropodist,  orthopedist  and 
the  general  practitioner  of  medicine. 

Cognizant  of  the  many  discomforts,  pains  and  improper  shapes, 
fitting  and  styles  of  shoe,  I  feel  assured  that  a  work  of  this  kind  in 
the  possession  of  the  shoe  man  will  render  him  more  proficient  in 
his  calling. 

To  be  familiar  with  the  structure  of  the  human  foot  and  its  de- 
formities, with  the  serious  consequences  of  the  improper  fitting  of 
sizes  and  shapes  of  shoes,  is  a  step  toward  the  abolition  of  many 
foot  ailments.  Thus,  a  careful  study  of  the  subjects  contained  in 
this  volume  will  enable  the  shoe  fitter  to  not  only  apply  correct 
remedial  measure,  but  to  remove  the  cause  giving  rise  to  these  de- 
formed conditions.  The  fitting  of  proper  shoes  and  hosiery,  and 
perhaps  a  modified  simple  appliance  will  render  much  foot  comfort  and 
shoe  satisfaction.  Considerable  good  can  be  accomplished  by  the 
profession  in  prescribing  proper  corrective  appliances  and  foot  gear. 

In  the  preparation  of  this  volume  reference  has  been  made  to  the 
works  of  Gray,  Cunningham,  Bradford,  Lovett,  Stimson  and  others 
for  which  acknowledgment  is  made. 


PREFACE 

Before  concluding,  I  wish  to  state  that  the  illustrations,  etc., 
shown  in  this  book  are  gathered  from  my  experience  in  the  mechanical 
treatment  of  weakened  and  deformed  conditions  of  the  foot,  with 
that  of  my  contemporary  colleagues,  extending  over  a  period  of  fifteen 
years. 

DR.  WM.  M.  SCHOLL. 


INTRODUCTION 


IN  the  study  of  anatomy — the  foundation  of  medical  science — we 
shall  confine  ourselves  more  particularly  to  a  general  and  detailed 
consideration  of  the  study  of  the  human  foot.  A  volume  might 
be  written  upon  anatomy  alone,  but  it  is  only  necessary  here  to  deal 
with  those  points  absolutely  essential  to  the  student  and  also  with 
the  structures  of  the  foot,  viz :  Bones,  muscles,  nerves,  etc.,  and  this 
course  has  been  followed  throughout. 

The  mechanical  consideration  of  the  foot,  its  abnormal  condition, 
causes  and  mechanical  treatment,  will  then  be  discussed.  Believing 
that  mechanical  treatment  affords  the  most  satisfactory  and  gratify- 
ing results,  I  have  included  various  chapters  describing  the  same 
that  the  student  may  familiarize  himself  with  the  proper  remedial 
appliances  and  their  mode  of  application. 

In  my  description  of  the  deformed  conditions  of  the  foot  I  dis- 
cuss the  various  joint  diseases  and  deformities  that  the  student  may 
be  better  enabled  to  recognize  those  cases  which  require  the  attention 
of  a  skilled  surgeon,  and  to  advise  the  patient  to  this  effect  that  the 
case  may  be  correctly  diagnosed  and  treated. 

Before  fitting  a  pair  of  arch  supports  it  is  advisable  to  determine 
if  the  deformity  is  not  of  systemic  origin ;  if  the  latter  the  patient 
should  be  referred  to  a  physician  at  once. 

The  shoe  being  an  important  adjunct  of  the  foot  and  the  prime 
causative  agent  of  deformities  it  will  be  discussed  at  length,  reverting 
to  the  origin  of  shoes  and  footwear  and  continuing  with  a  chronological 
history  of  shoes  worn  to  the  present  period. 

Suggestions  on  shoe  fitting,  construction,  last  measurements  and 
information  in  general  pertaining  to  this  subject  will  be  discussed  in 
the  following  chapters. 


CHAPTER    I 


THE   BONES 

In  order  to  thoroughly  comprehend  the  bony  structure  of  the  foot, 
it  is  advisable  to  give  a  description  of  the  framework  of  the  body. 


TAH5U5 

tlCJATARSUS 

PHAUM6CS 

Chart  No.  Al 
Skeleton  of  the  Human  Body. 


Bone  is  one  of  the  hardest  structures  of  the  body,  consisting  of  a 
dense,  compact  texture,  and  is  covered  by  a  fibrous  membrane  called 
Periosteum  from  which  the  bone  derives  its  nourishment. 


12  THE    HUMAN    FOOT 

Bones  form  the  framework  over  which  the  structures  are  built 
and  when  covered  with  muscles  and  flesh  make  the  contour  perfect. 

BONES  OF  THE  HUMAN  BODY 

The  human  body  has  as  its  foundation  a  framework  of  approxi- 
mately two  hundred  bones,  and  of  this  number  there  are  twenty-six 
bones  in  each  foot,  and  as  this  concerns  the  student  most,  the  upper 
extremity  will  be  entirely  omitted.  The  bones  of  the  lower  extremities 
consist  of  the  thigh,  leg  and  foot. 

The  Pelvis  is  most  massively  constructed,  a  heavy,  bony  ring  inter- 
posed between  the  end  of  the  spine  which  it  supports,  and  the  lower 
extremities  upon  which  it  rests. 

Next  to  the  Pelvis  comes  the  Thigh.  The  Thigh  is  that  portion 
which  is  situated  between  the  Pelvis  (beginning  at  the  hip)  and  the 
Knee.  It  consists  in  the  skeleton  of  a  single  bone,  the  Femur  (thigh- 
bone), which  is  the  longest,  strongest  and  largest  bone  in  the  skeleton. 

The  skeleton  or  bones  of  the  leg  consist  of  the  Tibia  and  Fibula, 
and  the  Patella  or  Knee  Cap.  The  Tibia  is  situated  at  the  front  and 
inner  side  of  the  leg  and,  excepting  the  Femur,  is  the  largest  and 
longest  bone  in  the  skeleton.  It  articulates  with  the  knee-joint  above 
and  with  the  Astragalus  or  key-bone  of  the  arch  below. 

The  Fibula  is  situated  at  the  outer  side  of  the  leg.  It  is  the  smaller 
of  the  two  bones  and,  in  proportion  to  its  length,  the  most  slender 
of  all  the  long  bones.  The  Fibula  acts  as  a  balance  to  the  Tibia,  and 
in  case  of  fractures  they  are  both  usually  broken.     (See  Chart  No.  1.) 

As  the  foot  receives  the  entire  weight  of  the  body,  is  it  not  natural 
to  assume  that  this  part  of  the  body  is  most  likely  to  become  dis- 
torted, as  is  the  fact?  For  example,  we  will  take  a  person  weighing 
two  hundred  pounds.  Just  think  of  the  pressure  exerted  upon  the 
weak  framework  of  the  foot.  In  such  individuals  we  find  flat-foot 
to  be  a  general  affliction.  That  the  various  resulting  deformities 
may  be  thoroughly  understood,  it  is  necessary  to  be  familiar  with 
the  different  bones  which  make  up  the  framework  of  a  foot.     Thus, 


BONES    OF    THE    FOOT 


13 


referring  you   to   Chart  No.   3,   I   have   divided   the   foot   into   three 
principal  parts  for  the  convenience  of  the  student. 

1.  Phalanges  or  Toes. 

2.  The  Metatarsus. 

3.  Tarsus  or  Heel  and  Ankle  Joint. 


Chart  No.    1 
Bones  of  Leg  and  Foot. 


Now  let  us  take  up  each  one  separately.  You  will  notice  by 
Chart  No.  2  that  each  toe  has  three  bones,  called  Phalanges,  except 
the  large  toe,  that  only  having  two  bones.  The  Metatarsus  has  five 
bones,  called  Metatarsal  bones.  Notice  that  the  Metatarsus  has  as 
many  bones  as  there  are  toes  on  a  foot,  and  each  corresponds  to  the 


14 


1st  DISTAL  PH 


THE    HUMAN    FOOT 

2nd  DISTAL  PHALANX 

2nd  MEDIAL  PHALANX 
2nd  PROXIMAL     » 
3BD  DISTAL      " 
3rd  MEDIAL       " 


3RD.PR0XIMAL        •' 
4th  DISTAL  " 

4.™  MEDIAL      »» 
4T,H  PROXIMAL  PHALANX 

5T"  DISTAL  »• 

5  th  MEDIAL         »» 

5THPR0XIMAL         '• 
1st  METATARSAL 

2ND  fl 

3RD  II 

4-TH  II 

5th  •• 

INTERNAL  CUNEIFORM 

MIDDLE  »' 

EXTERNAL  » 

SCAPHOID 

CUBOID 

ASTRAGALUS 

OSCALSIS 


Chart  No.  2 
Bones  of  the  Foot,  Dorsal  or  Top  View. 


BONES    OF    THE    FOOT 


15 


1st  Distal  Phalanx. 
1st  Proximal  Phalanx. 

Sesamoid. 
Sesamoid. 

1st  Metatarsal. 


Internal  Cuneiform. 
Middle  Cuneiform. 
External  Cuneiform. 
Scaphoid. 

Cuboid. 

Astragalus. 

Sustentaculum  Tali. 


Os  Calcis. 


Chart  No.  A3><  .. 
Bones  of  the  Foot,  Plantar  or  Bottom  View. 


16 


THE    HUMAN    FOOT 


respective  toe.     Next  is  the  Tarsus,  which  also  includes  the  Ankle 
Joint.     This  has  seven  bones,  as  follows : 

Three  Cuneiform,  Scaphoid,  Cuboid,  Astragalus  and 
Os  Calcis. 

It  is  a  very  easy  matter  to  remember  the  number  of  bones  in  the 
foot.  If  you  will  remember,  each  toe  has  three  bones,  except  the  large 
toe,  it  having  one  less.  Everybody  knows  there  are  five  toes  on 
every  foot,  so  consequently  there  are  fourteen  bones  in  the  five  toes 
on  each  foot.  The  Metatarsus  has  one  bone  for  each  toe,  consequently 
the  Metatarsus  contains  five  bones,  making  nineteen  bones  for  toes 
and' Metatarsus  together.     Now,  if  there  are  twenty-six  bones  in  all 


PHALANGES 


Chart  No.  3 
Dividing  the  Foot  into  the  Three  Groups  of  Bones. 


in  the  foot,  there  remain  but  seven  bones  for  the  Heel  and  Ankle  Joint. 
Again,  each  bone  forms  a  joint  with  the  succeeding  bone,  so  in  the 
toes  we  have  several  joints.  Any  one  of  these  bones  may  be  distorted, 
forming  a  malformation  of  the  foot.  The  bones  of  the  Arch  and 
Ankle  have  several  joints  which  may  in  turn  be  distorted  and  produce 
a  malformation. 

It  is  very  plain  from  the  foregoing  that  the  knowledge  of  the 
different  bones  of  the  foot  is  of  the  utmost  importance  to  a  foot 
specialist.  Let  us  now  continue  to  explain  the  relation  of  the  muscles, 
ligaments,  arteries  and  nerves  of  the  foot  to  the  bones  before  we  take 
up  the  study  of  each  individual  bone.  Each  bone  in  the  foot  is  sup- 
plied with  arteries,  nerves  and  a  number  of  muscles  and  ligaments. 
Later  on  we  shall  consider  the  minute  details  of  every  artery,  nerve, 


BONES    OF    THE    FOOT  17 

muscle  and  ligament,  but  at  this  moment  it  will  serve  our  purpose  to 
refer  to  the  same  in  a  general  way. 

Take,  for  instance,  the  muscles  and  ligaments  which  are  attached 
to  the  toes  and  arch  of  the  foot,  which  are  constantly  stretched  when 
a  person  walks.  Should  the  pressure  be  too  great,  these  muscles  and 
ligaments  become  weakened,  and  the  bones  of  the  foot  do  not  have 
their  support,  the  result  being  a  displacement  of  that  bone  whose 
muscles  and  ligaments  have  been  weakened.  Let  us  now  consider 
why  these  conditions  would  be  painful. 

The  distorted  bone  or  malformation  may  press  against  a  nerve, 
producing  pain,  or  it  may  press  against  an  artery,  which  would  in- 
terfere with  the  natural  circulation  of  the  blood  supply  in  the  foot. 
Before  continuing  with  the  next  chapter,  I  recommend  the  re-reading 
of  Chapter  I,  as  it  should  be  thoroughly  comprehended  in  order  to 
master  the  description  of  each  bone  of  the  foot. 


CHAPTER    II 


THE    TARSUS 

Referring  you  again  to  Chart  No.  2,  you  will  find  each  bone  of 
the  foot  represented  by  its  respective  name.  In  the  previous  chapter 
I  called  your  attention  to  the  fact  that  the  foot  had  twenty-six  bones 
and  that  the  heel  and  ankle  joint  contained  seven  bones.  I  will  here 
describe  each  bone  separately. 

For  our  convenience  we  will  commence  with  the  heel.  I  now 
refer  you  to  Chart  No.  3,  where  you  will  again  find  the  foot  divided 
into  three  different  parts,  but  each  part  is  named  respectively: 

The  Tarsus,  which  is  the  back  part  of  the  foot,  includes  the  heel 
and  ankle  joint. 

The  Metatarsus  or  the  middle  part  of  the  foot  has  the  appearance 
of  an  arched  bridge. 

The  Phalanges  or  the  front  part  of  the  foot  includes  all  the  bones 
of  the  toe. 

1.  The  Os  Calcis  or  Heel  Bone  is  the  largest  and  strongest  bone 
of  the  foot,  and  is  situated  at  the  back  of  the  foot  in  front  of  which 
are  the  Astragalus  and  Cuboid  bones.  Referring  to  Chart  No.  3  you 
will  see  that  this  bone  forms  the  heel  and  is  irregular  and  cuboidal 
in  shape.  The  chief  facts  about  this  bone  to  be  remembered  are 
that  it  transmits  the  weight  of  the  body  to  the  ground  and  that  it 
articulates  with  the  next  two  bones,  the  Astragalus  and  Cuboid.  It 
is  held  in  its  position  by  strong  ligaments.  The  muscles  of  the  calf 
of  the  leg  and  Achillis  tendon  are  also  attached  to  this  bone.  The 
importance  of  this  bone  is  readily  observed  in  deformities  of  the  foot. 

2.  The  Astragalus  Bone. — As  you  will  notice  in  Chart  No.  2, 
the  next  bone  to  the  Os  Calcis  is  the  Astragalus.  It  is  also  the  next 
largest  bone  of  the  Tarsus,  and  is  situated  in  front  of  the  Os  Calcis 
and  is  the  middle  bone  of  the  Tarsus,  being  supported  underneath 

18 


THE    TARSUS  19 

by  a  part  of  the  Os  Calcis  and  articulates  in  front  with  the  Scaphoid 
bone.  The  upper  surface  of  the  Astragalus  is  so  shaped  as  to  receive 
the  bone  of  the  leg. 

This  bone  is  called  the  Tibia,  and  as  the  weight  of  the  entire  body 
is  transmitted  through  the  leg  and  is  received  at  the  upper  part  of 
the  Astragalus,  it  can  be  clearly  understood  that  this  bone  is  the 
most  important  one  of  the  lower  appendages,  and  liable  to  succumb 
under  the  great  weight  borne,  producing  the  deformity  known  as 
flat-foot.  This  bone  has  strong  ligament  and  muscle  attachments, 
which  are  frequently  stretched  by  the  constant  strain  placed  upon 
them,  causing  the  Astragalus  to  be  displaced. 

3.  The  Scaphoid  Bone. — This  is  the  bone  which  I  described  as 
being  immediately  in  front  of  the  Astragalus. 

On  the  chart  you  will  readily  notice  that  this  bone  is  situated  on 
the  inner  side  of  the  Tarsus,  and  articulates  with  the  Astragalus 
behind  and  with  the  three  Cuneiform  bones  in  front.  From  its  posi- 
tion in  the  Tarsus,  it  is  evident  that  the  Scaphoid  bone  also  plays 
an  important  part  in  flat-foot  cases,  as  it  is  also  in  the  center  of  the 
foot  and  can  be  readily  felt  in  such  deformities. 

4.  The  Cuboid  Bone. — This  is  the  bone  which  is  situated  on  the 
outer  side  of  the  Tarsus,  immediately  in  front  of  that  part  of  the 
Os  Calcis  which  does  not  articulate  with  the  Astragalus.  You  will 
notice  by  the  chart  that  the  Cuboid  bone  fills  up  that  space  between 
the  outer  side  of  the  Os  Calcis  and  the  fourth  and  fifth  Metatarsal 
bones.  The  Cuboid  also  articulates  with  the  External  Cuneiform 
bone.  There  is  no  doubt  that  this  bone  is  usually  involved  in  condi- 
tions of  flat-foot. 

5.  Internal  Cuneiform  Bone. — There  are  three  Cuneiform  bones, 
namely,  the  Internal,  Middle  and  External.  They  are  thus  named 
according  to  their  location,  as,  for  instance,  the  Internal  Cuneiform 
which  we  are  about  to  describe  is  situated  on  the  internal  surface 
of  the  Tarsus.  It  is  located  immediately  in  front  of  the  Scaphoid 
bone  and  articulates  with  the  Scaphoid  behind,  the  first  Metatarsal 
bone  in  front,  and  on  the  side  with  the  Middle  Cuneiform  and  part 
of  the   second   Metatarsal   bone.     The   relation   of  this   bone   shows 


20  THE    HUMAN    FOOT 

plainly  that  it  is  very  often  distorted  as  are  the  other  bones  of  the 
Tarsus. 

6.  Middle  Cuneiform  Bone. — This  bone  is  so  named  because  it  is 
situated,  between  the  Internal  and  External  Cuneiform  bones. 

It  is  the  smallest  of  the  three  Cuneiform  bones  and  articulates 
with  the  Scaphoid  behind  and  the  second  Metatarsal  bone  in  front, 
with  the  Internal  Cuneiform  on  the  inner  side  and  the  External  Cunei- 
form on  the  outer  side.  The  relative  position  of  this  bone  is  identical 
with  that  of  the  other  Cuneiform  bones,  which  are  invariably  affected 
by  any  displacement  of  the  bones  of  the  Tarsus. 

7.  External  Cuneiform  Bone. — This  is  the  last  bone  of  the  Tarsus 
to  be  described.  It  is  situated  in  the  middle  of  the  foot,  and  for 
this  reason  receives  a  considerable  degree  of  pressure.  It  articulates 
with  the  Scaphoid  behind,  the  third  Metatarsal  bone  in  front  and  the 
Cuboid  and  part  of  the  fourth  Metatarsal  bone  on  the  outer  side,  and 
also  with  the  middle  Cuneiform  on  the  inner  side. 

We  have  now  considered  all  seven  bones  of  the  Tarsus;  thus  you 
will  notice  that  the  last  six  bones  go  to  make  up  part  of  the  arch  of 
the  foot  which  is  so  important  in  flat-foot  subjects.  In  the  next 
chapter  we  will  describe  the  five  Metatarsal  bones  which  make  up 
the  other  part  of  the  arch. 


CHAPTER    III 


THE  METATARSUS  AND  THE  PHALANGES 


THE  METATARSUS 

The  Metatarsus  consists  of  the  five  Metatarsal  bones,  numbered 
one  to  five,  number  one  commencing  at  the  great  toe. 

1.  First  Metatarsal  Bone. — This  is  the  shortest  but  thickest  bone 
of  the  Metatarsals.  It  articulates  with  the  Internal  Cuneiform  bone 
behind  and  with  the  first  Phalanx  of  the  large  toe  in  front. 

2.  Second  Metatarsal  Bone. — This  is  the  longest  of  the  Metatarsal 
bones.  It  is  situated  between  the  first  and  third  Metatarsal  bones 
and  articulates  with  the  Middle  Cuneiform  bone  and  part  of  the 
Internal  and  External  Cuneiform  bones  behind  and  laterally  with 
the  third  Metatarsal  bone. 

3.  Third  Metatarsal  Bone. — There  is  nothing  particular  to  re- 
member about  this  bone,  except  that  it  articulates  with  the  External 
Cuneiform  bone  behind  and  laterally  with  the  second  Metatarsal  bone 
on  the  inner  side  and  the  fourth  Metatarsal  bone  on  the  external  side. 

4.  Fourth  Metatarsal  Bone.— In  describing  this  bone  all  one  has 
to  remember  is  that  it  articulates  with  the  Cuboid  bone  and  External 
Cuneiform  bone  behind,  the  third  Metatarsal  bone  internally  and 
the  fifth  Metatarsal  bone  externally. 

5.  Fifth  Metatarsal  Bone. — It  is  the  smallest  of  the  Metatarsal 
bones  and  is  situated  on  the  outer  side  of  the  foot.  It  articulates 
with  the  Cuboid  behind  and  laterally  with  the  fourth  Metatarsal  bone. 

This  concludes  the  description  of  all  the  bones  of  the  arch  of 
the  foot.  In  the  previous  chapters  I  called  your  attention  to  the 
fact  that  all  these  bones  had  muscles  and  ligaments  attached  to  them. 
They  play  an  important  part  in  malformations  of  the  foot,  and  you 
must  always  bear  in  mind,  when  we  find  a  malformation,  that  these 
muscles  and  ligaments  are  generally  affected. 

21 


22  THE  HUMAN  FOOT 

THE  PHALANGES  OR  BONES  OF  THE  TOES 

Each  toe,  as  you  remember,  has  three  Phalanges,  except  the  large 
toe,  which  has  only  two. 

The  Phalanges  which  articulate  with  their  respective  Metatarsal 
bones  are  called  the  first  Phalanx  of  each  toe,  consequently  the  next 
Phalanx  in  each  toe  is  called  the  second  or  Medial  Phalanx,  and  the 
last  Phalanx  is  called  the  third  or  Distal  Phalanx.  Of  course  there  is 
not  a  third  Phalanx  in  the  large  toe,  as  that  toe  only  has  two 
Phalanges.  In  order  to  understand  with  what  bones  they  articulate 
I  refer  you  to  Chart  No.  2,  and  there  you  will  notice  that  the  first 
Phalanges  articulate  with  their  respective  Metatarsal  bones  behind 
and  with  the  second  Phalanx  of  each  toe  in  front. 

The  second  Phalanx  in  each  toe  articulates  with  the  first  Phalanx 
behind  and  the  third  Phalanx  in  front.  Again  the  exception  is  the 
large  toe,  as  previously  stated;  it  has  only  two  Phalanges. 

That  leaves  the  four  Distal  or  third  Phalanges  to  be  described. 
They  articulate  with  the  second  Phalanx  of  each  toe  behind  and  are 
flattened  in  front  so  as  to  receive  the  nail  of  the  toes. 

The  Phalanges  play  an  important  part  in  malformation  of  the 
feet  as  they  are  often  distorted,  due  to  ill-fitting  shoes,  such  as  high 
heels  and  narrow-pointed  lasts.  Very  often  one  toe  overlaps  the 
other.     We  also  find  many  ingrown  toe  nails,  etc. 

These  conditions  will  all  be  described  as  we  advance.  Before  we 
proceed  I  must  call  your  attention  to  two  other  bones,  namely,  those 
two  bones  which  are  in  the  lower  limb,  for  they  are  the  bones  which  are 
received  by  the  Astragalus  and  are  part  of  the  ankle  joint.  The  large 
shin  bone  is  called  the  Tibia ;  the  smaller  bone,  which  is  located  on 
the  outer  side  of  the  large  bone,  is  called  the  Fibula.  I  believe  a  de- 
scription of  these  bones  would  enable  you  to  more  thoroughly  under- 
stand the  ankle  joint. 

THE    TIBIA 

Is  the  largest  of  the  two  bones  in  the  lower  part  of  the  leg.  It 
is  situated  in  front  and  the  inner  side  of  the  leg,  and  is  otherwise 
called  the  shin  bone.     The  upper  part  of  the  bone  is  called  the  head 


THE    METATARSUS  AND  THE  PHALANGES  23 

of  the  Tibia.  It  is  very  much  enlarged  at  the  head  and  articulates 
with  the  Femur  (which  is  the  thigh  bone)  to  form  the  knee  joint.  It 
then  tapers  gradually  until  it  reaches  the  lower  part  of  the  bone,  that 
part  between  the  head  of  the  Tibia  and  lower  extremity  being  called 


Arf/cu/aA 


wit/Jin 


TIBIA- 


FIBULA 


WITH  ASTRAGALUS' 

Chart  No.   7 

Bones  of  the   Right  I,eg 

Posterior  Surface. 


the  shaft  of  the  bone.  The  lower  extremity  is  smaller  than  the  upper 
one  and  it  articulates  with  the  Astragalus.  You  can  readily  see  the 
importance  of  this  bone  in  considering  the  ankle  joint.  The  lower 
part  of  the  bone  internally  forms  the  Internal  Malleolus.    The  Mai- 


24  THE    HUMAN    FOOT 

leolus  is  that  part  of  the  ankle  joint  which  is  most  prominent  on  the 
internal  side  of  the  ankle.  Many  muscles  are  attached  to  this  bone, 
which  also  are  attached  to  the  bones  of  the  foot.  The  outer  side  of 
the  head  of  the  Tibia  articulates  with  the  Fibula,  which  is  the  second 
bone  of  the  lower  leg.  The  outer  side  of  the  lower  extremity  of  the 
Tibia  also  articulates  with  the  Fibula.  I  refer  you  to  Chart  No.  7, 
which  will  explain  fully  the  relation  of  these  bones  to  each  other. 

THE    FIBULA 

The  small  bone  of  the  lower  part  of  the  leg  is  situated  on  the  outer 
side  of  the  Tibia  which  we  have  just  described.  It  is  much  thinner 
and  articulates  above  with  the  outer  side  of  the  Tibia,  running  parallel 
with  the  same,  and  being  situated  directly  in  back  of  it  at  the  lower 
extremity,  it  inclines  a  little  forward  and  projects  a  little  below  the 
Tibia,  forming  the  outer  prominence  of  the  ankle  joint  or  External 
Malleolus.  This  bone  as  well  as  the  preceding  one  has  many  muscles 
and  ligaments  attached  to  it,  which  also  are  attached  to  the  bones  of 
the  foot.  The  function  of  this  bone  is  to  act  as  a  balance  to  the 
Tibia  in  transmitting  the  weight  into  the  foot.  It  is  important  for 
the  student  to  master  each  bone  of  the  foot  and  leg  thoroughly, 
making  it  unnecessary  to  consult  the  charts  every  time  you  read  about 
them.  For  this  reason  I  emphasize  the  necessity  of  studying  the 
different  charts  and  the  description  of  each  bone. 

In  the  next  chapter  we  will  consider  the  arches  of  the  foot.  As 
you  have  made  yourself  familiar  with  the  names  of  the  bones  and 
have  a  mind  picture  of  their  shapes  and  sizes,  it  will  not  be  difficult 
for  you  to  now  thoroughly  understand  the  anatomical  descriptions. 
The  arches  are  very  important  in  foot  trouble  cases. 


CHAPTER    IV 


ARCHES   OF  THE   FOOT 

The  bones  of  the  foot  are  arranged  to  adapt  themselves  best 
for  their  work,  and  are  so  joined  to  form  two  distinct  arches — the 
Longitudinal  Arch  and  the  Transverse  Arch. 

Some  writers  mention  that  there  are  three  by  taking  in  the  Outer 
Longitudinal  x\rch,  and  others  say  there  are  four  by  taking  the  Trans- 
verse Arch  and  the  Anterior  Metatarsal  Arch  as  separate  arches,  but 
we  will  describe  the  Longitudinal  Arches,  both  inner  and  outer,  and 
the  Anterior  Transverse  Arch.     (See  Chart  No.  4.) 


TIBIA 


INTERNAL 
I  CUNEIFORM  I  ASTRAGALUS 

|    METATARSALS  SCAPHOID  OSCALSIS 

sesamoid  LONGITUDINAL  ARCH 

Chart  No.  4 
Bones  of  Foot   Showing  Inner  Longitudinal  Arch. 

INNER  LONGITUDINAL  ARCH 

The  inner  Longitudinal  Arch  carries  most  of  the  weight.  It  is 
composed  of  the  Os  Calcis  from  behind  as  furnishing  the  main  sup- 
port and  the  head  of  the  first  Metatarsal  furnishing  the  forward 
support.  It  extends  from  the  inner  side  of  the  Os  Calcis  and  is 
composed  of  the  Os  Calcis,  the  Astragalus,  the  Scaphoid,  the  Internal 
Cuneiform  and  the  first  Metatarsal. 

25 


26  THE    HUMAN    FOOT 

OUTER    LONGITUDINAL   ARCH 

The  outer  Longitudinal  Arch  extends  from  the  outer  side  of  the 
bottom  of  the  Os  Calcis  to  the  head  of  the  fifth  Metatarsal,  and  is 
composed  of  the  Os  Calcis,  Cuboid  and  fifth  Metatarsal,  this  being 
the  shorter  arch  and  not  frequently  disturbed  in  ordinary  cases.  The 
two  arches  to  bear  in  mind  are  the  inner  Longitudinal  Arch  and  the 
Anterior  or  Transverse  Arch.     (See  Chart  No.  5.) 

These  arches  are  supported  mainly  by  ligaments,  and  the  Longi- 
tudinal Arch  is  weakest  between  the  Astragalus  and  the  Cuneiform 
where  it  is  very  liable  to  yield,  giving  cause  to  flat-foot. 


OUTSIDE  VIEW 


Chart  No.  5 
Showing  Outer  Longitudinal  Arch. 


THE    TRANSVERSE    OR    ANTERIOR    ARCH 

This  arch  extends  across  the  ball  of  the  foot  from  the  outside  of 
the  head  of  the  first  Metatarsal  to  the  outside  of  the  fifth  Metatarsal. 
It  is  composed  of  the  second,  third  and  fourth  Metatarsal  in  addition 
to  the  first  and  fifth. 

This  arch  plays  an  important  part  in  the  mechanics  of  the  foot, 
as  it  provides  for  the  elasticity  as  well  as  the  strength  of  the  foot 
and  permits  of  space  for  the  muscles,  nerves  and  blood  vessels  of  the 
sole  of  the  foot  to  protect  them  from  pressure.  The  Metatarsal  heads 
which  go  to  make  up  the  Anterior  Transverse  Arch  are  very  fre- 
quently subjected  to  displacement,  creating  much  disturbance  to  the 
foot.     (See  Chart  No.  A6.) 


ITS    STRUCTURE 


27 


ANTERIOR 

TRANSVERSE 

ARCH 


TRANSVERSE 
ARCH 


>  PHALANGES 


1st  METATARSAL 

3RD  ft 

4.TH  ,i 

5th  " 

INTERNAL  CUNEIFORM 

MIDDLE  " 

EXTERNAL         " 

SCAPHOID 

CUBOID 

ASTRAGALUS 

OSCALSIS 


Chart  No.  6 
Showing  Transverse  and  Anterior  Transverse    (or   Metatarsal)   Arch. 


28 


THE    HUMAN    FOOT 


We  have  considered  the  entire  bony  structure  of  the  foot  and 
ankle  joint,  and  it  would  now  be  advisable  to  explain  to  you  in  a 
general  way,  first,  what  keeps  these  bones  in  their  respective  posi- 


Chart  No.   A6 
Arrows  Point  to  Line  of  Dome  Forming  the  Transverse  Arch. 


tions.  The  best  way  to  understand  this  is  by  considering  each  struc- 
ture, such  as  ligaments,  muscles,  tendons,  arteries,  veins  and  nerves 
separately,  then  later  describe  their  location,  etc. 


CHAPTER   V 


SOFT   STRUCTURES   OF  THE   FOOT 

In  order  that  we  may  clearly  understand  each  one  of  these  various 
structures,  we  must  know  of  what  they  consist  and  their  action. 
Thus,  let  us  study  that  first. 


LIGAMENTS 

Each  bone  of  the  skeleton  joins  another  bone,  this  producing  a 
joint  of  the  two  respective  bones,  which  are  held  together  by  liga- 
ments consisting  of  tough  fibrous  bands  of  tissues.  We  can  thus 
define  a  ligament  as  follows :  A  strong  fibrous  band  of  tissue,  whose 
function  is  to  hold  the  bony  joints  in  their  respective  places ;  com- 
posed of  waving  bands  of  white  fibrous  tissue  held  together  by  a 
semi-fluid  substance,  pliant  and  flexible,  to  allow  freedom  of  move- 
ment but  inextensible  so  as  not  to  readily  yield  under  pressure.  In 
ligaments  and  tendons  these  bundles  run  parellel  with  each  other. 
They  are  exceedingly  strong  so  that  upon  the  application  of  external 
violence  the  bone  with  which  it  is  connected  will  fracture  before  the 
fibrous  tissue  would  be  ruptured.  Continuous  strain  may  cause  liga- 
ments to  lose  their  normal  tone  and  toughness.  Whereas  the  tendons 
are  composed  of  the  same  tissue  as  ligaments,  we  will  consider 
them  next. 


TENDONS 

Tendons  are  white  fibrous  cords  varying  in  length  and  thick- 
ness. Sometimes  they  have  a  round,  sometimes  a  flattened  appear- 
ance ;  very  strong  in  texture,  but  having  no  elasticity.    These  fibers  run 

29 


30  THE    HUMAN    FOOT 

parallel  with  each  other  as  in  the  ligaments,  and  are  composed  of  the 
same  kind  of  fibrous  tissue.  The  tendons  serve  to  connect  the  muscles 
to  the  bony  structures,  and  in  many  instances  appear  almost  like  a 
continuation  of  a  muscle.  You  will  notice  I  am  taking-  the  structures 
of  the  foot  from  the  innermost  part,  outward.  First  we  considered 
the  bony  structure  in  full ;  then  I  gave  you  a  description  of  the  liga- 
ments which  are  the  structures  next  to  the  bones  and  serve  to  hold 
them  in  their  respective  positions.  Then  the  tendons,  which  form  the 
link  between  the  muscles  and  the  bones  and  serve  as  levers,  and  trans- 
mit the  action  from  the  muscles  to  the  different  bones  when  movement 
of  a  joint  is  required. 

MUSCLES 

Now  we  are  to  consider  the  muscle  tissue  and  its  function  in 
general.  Muscles  are  defined  as  follows :  A  muscle  is  a  bundle  of 
fibers  intermingled  with  arteries,  veins  and  nerves  varying  in  the 
arrangement  according  to  their  attachment  as,  for  instance,  where 
muscles  are  attached  to  bony  structure  they  terminate  in  blunt  ex- 
tremities upon  the  covering  of  the  bone.  Should  they  be  attached 
to  tendons  their  fibers  gradually  taper  into  a  small  bundle  of  fibers 
and  are  connected  with  fibrous  tissue  to  the  tendons. 

We  have  different  shapes  of  muscles  such  as  long,  broad,  short, 
etc.  These  terms  will  be  used  later  when  we  describe  each  individual 
muscle.  For  instance,  we  find  long  muscles  in  the  leg  and  short 
muscles  in  the  foot. 

The  upper  part  of  a  muscle  is  generally  termed  the  origin  of  a 
muscle,  the  middle  part  the  belly  and  the  lower  the  extremity  or 
insertion  end  of  the  muscle.  I  could  expatiate  upon  the  above  descrip- 
tion of  ligaments,  tendons  and  muscles,  but  I  believe  the  foregoing 
will  suffice  to  give  you  a  general  idea  of  these  structures.  Next  in 
order  come  the  arteries,  veins  and  nerves.  The  arteries  are  very 
important  structures,  as  they  convey  the  blood  which  nourishes  the 
different  tissues  of  the  body  to  all  parts  of  the  human  anatomy. 


SOFT   STRUCTURES   OF  THE   FOOT  31 

ARTERIES 

They  are  cylindrical  tubular  vessels  which  are  made  up  of  three 
coats  of  tissues.  The  inner  coat  consists  of  a  layer  of  cells  called 
epithelium,  the  middle  coat  consists  of  elastic  and  muscular  fibers  of 
tissue  arranged  in  a  circular  manner,  and  the  external  or  third  coat 
mostly  of  elastic  and  connective  tissues. 

Let  me  call  your  attention  to  the  circulation  of  the  blood  in  those 
arteries,  etc.  The  blood  is  expelled  from  the  heart  through  the  large 
arteries  of  the  body.  These  large  arteries  branch  of!  into  smaller 
arteries  called  branches,  and  they  again  are  subdivided  into  smaller 
vessels  called  capillaries. 

You  may  liken  the  arterial  system  to  a  tree.  The  tree  has  branches 
and  these  branches  again  give  off  smaller  branches.  So  we  find  that 
the  blood  is  distributed  all  over  the  body  through  these  different 
arteries,  branches  and  capillaries.  Again  the  blood  is  returned  to 
the  heart  through  a  system  of  veins  which  we  are  about  to  consider. 

VEINS 

The  veins,  like  the  arteries,  are  composed  of  three  coats,  namely, 
the  internal,  middle  and  external  coat.  These  coats  are,  with  the 
necessary  modifications,  analogous  to  the  coats  of  the  arteries,  the  in- 
ternal being  made  up  of  an  epithelial  layer  of  cells,  the  middle  of  mus- 
cular fibers,  and  the  external  of  connective  tissue.  The  main  difference 
you  will  notice  between  the  coats  of  the  arteries  and  those  of  the 
veins  is  in  the  middle  coat,  which  in  the  veins  is  composed  of  muscular 
tissue  only,  consequently  making  it  a  much  stronger  structure.  Most 
of  the  veins  are  provided  with  valves  which  serve  to  prevent  the  reflux 
of  the  blood.  These  valves  are  formed  by  reduplications  of  the  inner 
coats  of  the  veins  strengthened  by  connective  tissue  and  elastic  fibers, 
and  are  semilunar  in  form. 

There  remain  only  the  nerves  to  be  described  in  a  general  way, 
and  then  we  have  considered  all  the  soft  tissues  which  we  find  in 
the  study  of  the  leg  and  foot,  and  that  which  pertains  to  their  general 
characteristics. 


32  THE    HUMAN    FOOT 

NERVES 

Under  this  heading  I  could  include  the  minute  description  of  every 
nerve  tissue  in  the  body,  but  as  it  would  burden  you  with  unnecessary 
material  requiring  considerable  time  and  study  I  have  decided  to 
discuss  only  that  which  would  be  of  value  in  your  work.  You  may 
liken  the  nervous  system  to  the  telephone  system. 

In  the  latter  we  have  a  central  office  from  which  wires  radiate 
in  all  directions  and  messages  are  received  from  the  outside  to  the 
central  station.  So  we  have  the  same  conditions  existing  in  the 
nervous  system,  namely,  the  brain  of  a  person  is  called  the  central 
nervous  system,  and  from  this  center  the  spinal  nerves  and  other 
branches  originate,  consequently  any  stimulus  from  without  or  within 
would  send  a  message  to  the  brain  or  central  nervou's  system  to  act 
For  instance,  when  a  person  sees  something  falling  and  wishes  to 
pick  it  up,  the  central  nerves  send  messages  to  the  nerves  in  the 
muscles  of  the  arm  to  act,  I  believe  this  a  comprehensive  illustration. 
We  will  now  continue  with  a  description  of  the  tissues  which  make 
up  a  nerve. 

Xerve  tissue  is  composed  of  two  substances,  namely,  gray  matter 
and  white  or  fibrous  matter.  The  gray  matter  is  'mostly  found  in 
the  brain,  spinal  cord  and  some  of  the  nerves  of  special  sense,  which 
is  intermingled  with  a  fibrous  nervous  substance.  We  then  must 
consider  the  nerves,  as  they  are  really  what  we  have  to  deal  with. 
We  find  nerve  cells  called  neurons  distributed  throughout  the  nervous 
system;  then  we  have  nerve  fibers,  some  being  enclosed  in  a  sheath 
while  others  are  not.  They  generally  run  in  bundles  from  the  different 
nerve  centers  enclosed  in  a  sheath  to  all  parts  •  '  the  body,  as  I  ex- 
plained above.  So  we  find  branches  of  nerves  in  all  parts  of  the  body, 
the  foot  also  having  its  share.  Should  there  be  any  displacement  of 
bones  they  in  turn  would  press  on  a  nerve  filament  and  produce  ex- 
cruciating pain.  This  concludes  the  description  of  the  soft  parts  of 
the  foot  in  a  general  way.  We  will  now  consider  each  ligament, 
tendon,  muscle,  artery,  vein  and  nerve  separately. 


CHAPTER   VI 


THE   LIGAMENTS 

Under  this  heading  we  are  obliged  to  consider  all  ligaments 
which  may  have  all  or  partial  influence  on  the  movements  of  the 
ankle  joint  and  foot,  and  for  this  reason  it  is  best  to  start  with  those 
ligaments  that  connect  the  two  bones  in  the  lower  limb,  namely,  the 
Tibia  and  Fibula. 

TIBIO-FIBULAR    LIGAMENTS 

The  Fibula  is  connected  with  the  Tibia  by  an  interosseous  mem- 
brane in  the  middle,  and  at  the  upper  and  lower  ends  by  ligaments. 
The  ligaments  of  these  two  bones  are  divided  into  three  sets. 

1.  The  Superior  or  Upper  Tibio-Fibular  ligaments. 

2.  The  Middle  Tibio-Fibular  or  Interosseous  membrane. 

3.  The  Inferior  Tibio-Fibular  ligaments. 

1.  The  Superior  or  Upper  Ligaments  are  two  in  number,  called 
the  Anterior  and  Posterior  Tibio-Fibular  ligaments. 

2.  The  Middle  Tibio-Fibular  Ligament  is  a  membrane  extending 
from  the  margin  of  the  Fibula  and  Tibia.  It  is  continuous  below 
with  the  Inferior  Interosseous  ligament. 

3.  The  Inferior  Tibio-Fibular  Ligaments  are  of  more  importance 
for  our  study  than  the  foregoing  two  sets  of  ligaments,  as  the  inferior 
are  directly  connected  with  the  ankle  joint,  and  for  this  reason  will 
give  a  more  elabor  .e  description  of  these. 

THE  INFERIOR  TIBIO-FIBULAR  LIGAMENTS 

Are  four  in  number,  namely : 

1.  Anterior  Inferior  Tibio-Fibular. 

2.  Posterior  Inferior  Tibio-Fibular. 

3.  Transverse. 

4.  Inferior  Interosseous. 

33 


34 


THE    HUMAN    FOOT 


Referring  to  Chart  No.  8  you  will  notice  their  relations  to  the 
bones. 

1.  The  Anterior  Inferior  Tibio-Fibular  Ligament  is  a  flat  triangu- 
lar band  of  fibers  broader  below  than  above  and  is  situated  in  front 
between  the  Fibula  and  Tibia,  extending  from  the  margin  of  one 
bone  to  the  margin  of  the  other,  at  the  lower  end  of  the  bones 
just  above  the  ankle  joint  and  comes  in  contact  with  the  Astragalus 


INTEROSSEOUS 


Tibuip} 


lNF£RIOri  TlBlD-f/BVIfiJi 

.jnamaa  us. 


Chart  No.  8 
Ligaments   of  Ankle   Joint. 
(Right  Foot,  Outside  View) 


2.  The  Posterior  Inferior  Tibio-Fibular  Ligament  is  of  the  same 
kind  of  tissue,  but  is  smaller  than  the  anterior;  in  fact  the  description 
of  the  posterior  is  the  same  except  that  this  ligament  is  located  pos- 
teriorly at  the  same  position  as  is  the  anterior  ligament.  (See  Chart 
No.  8.) 

3.  The  Transverse  Ligament  is  a  long,  narrow  band  continuous 
with  the  posterior  ligament  passing  transversely  across  the  back  of  the 
joint  from  the  external  Malleolus  to  almost  the  internal  Malleolus,  and 


THE    LIGAMENTS  35 

projects  a  little  below  the  joint  to  form  part  of  the  articulating  surface 
of  the  Astragalus. 

4.  The  Inferior  Interosseous  Ligament  consists  of  numerous  short, 
strong  fibrous  bands  which  pass  between  the  contiguous  rough  sur- 
faces of  the  Tibia  and  Fibula  and  constitute  the  chief  bond  of  union 
between  the  two  bones.  It  is  difficult  to  show  these  bands  on  a  chart, 
but  I  feel  certain  from  the  description  you  can  readily  understand  their 
location  and  action.     (See  Chart  No.  8.) 

LIGAMENTS  OF  THE  ANKLE  JOINT 

Next  we  are  to  consider  the  ligaments  of  the  ankle  joint.  They 
are  four  in  number,  namely : 

1.  Anterior. 

2.  Posterior. 

3.  Internal  Lateral. 

4.  External  Lateral. 

1.  The  Anterior,  or  Otherwise  Called  Anterior  Tibio-Tarsal  Liga- 
ment, with  reference  to  its  location,  is  a  broad,  thin  membranous 
layer  attached  above  to  the  anterior  margin  of  the  articular  surface  of 
the  Tibia  and  below  to  the  margin  of  the  Astragalus.  (See  Chart 
No.  9.) 

2.  The  Posterior,  or  Otherwise  Called  Posterior  Tibio-Tarsal 
Ligament,  is  also  very  thin  and  is  attached  to  the  posterior  margin  of 
the  Tibia  and  posterior  margin  of  Astragalus.     (See  Chart  No.  8.) 

3.  The  Internal  Lateral  Ligament,  or  Otherwise  Called  Deltoid 
Ligament,  consists  of  two  layers  of  fibers,  namely,  the  superficial  and 
deep  layers.  The  superficial  layer  is  a  strong,  flat  triangular  band  at- 
tached above  to  the  anterior  and  posterior  borders  of  the  Internal 
Malleolus.  You  will  notice  by  referring  to  Chart  No.  9  that  the  an- 
terior fibers  pass  forward  to  be  inserted  into  the  Scaphoid  and  Inferior 
Calcaneo-Scaphoid  ligament,  the  middle  fibers  descend  perpendicu- 
larly to  be  inserted  into  the  Os  Calcis,  the  posterior  fibers  pass  back- 
ward and  outward,  to  be  attached  to  the  inner  side  of  the  Astragalus. 

The  deep  layer  is  a  short,  thick  and  strong  bundle  of  fibers  and 
passes  from  the  Malleolus  to  the  inner  surface  of  the  Astragalus. 


36 


THE    HUMAN    FOOT 


4.  The  External  Lateral  Ligament  consists  of  three  bundles  of 
fibers,  taking  different  directions,  and  are  distinctly  separated.  They 
are  named  after  their  location,  namely,  the  Anterior  Fasciculus,  the 
Posterior  and  Middle  Fasciculus.  A  Fasciculus  is  a  bundle  of  fibers 
drawn  together. 

a.  The  Anterior  Fasciculus  is  the  shortest  of  the  three  and  passes 
from  the  anterior  margin  of  the  External  Malleolus  downward  and 
forward  to  the  front  of  the  Astragalus. 


—TIBIA 


Chart  No.  9 
Ligaments   of   Ankle  Joint. 
(Right  Foot,    Inside   View) 


b.  The  Posterior  Fasciculus  is  the  most  deeply  seated  and  passes 
from  the  posterior  surface  of  the  External  Malleolus  to  the  posterior 
surface  of  the  Astragalus. 

c.  The  Middle  Fasciculus  is  the  longest  of  the  three  and  appears 
like  a  narrow  rounded  cord  passing  from  the  External  Malleolus  down- 
ward and  backward  to  the  middle  of  the  outer  side  of  the  Os  Calcis. 

(The  above  is  very  well  illustrated  in  Chart  Xo.  8.) 

Referring  back  to  the  ligaments  of  the  ankle  which  we  just  de- 


THE    LIGAMENTS  37 

scribed,  it  is  at  once  evident  that  the  Internal  Lateral  or  Deltoid 
ligament  is  of  very  great  power,  and  that  the  Middle  Fasciculus 
of  the  External  Lateral  ligament  binds  the  bones  of  the  leg  firmly  to 
the  foot  and  resists  displacement  in  every  direction.  The  remaining 
ligaments  of  the  ankle  also  resist  displacement  of  the  bones,  and  are 
attached  to  them,  but  not  to  so  great  a  degree. 

THE  LIGAMENTS  OF  THE  TARSUS 

In  order  that  you  may  understand  the  arrangement  of  this  group 
of  ligaments,  it  is  necessary  that  we  refer  back  to  the  bones  of  the 
Tarsus.  (See  Chart  No.  3.)  The  bones  are  arranged  in  almost  two 
separate  rows.  In  the  first  row  we  will  consider  the  Ds  Calcis  and 
the  Astragalus,  and  in  the  second  row  the  Scaphoid,  Cuboid  and  three 
Cuneiform  bones.  Therefore,  in  studying  the  ligaments  which  connect 
these  bones,  we  will  for  simplicity  divide  them  also  into  two  respective 
rows,  with  an  additional  row  which  connects  the  Os  Calcis  to  the 
Cuboid  and  the  Scaphoid  bones  separately.  The  first  row  has  three 
ligaments,  namely: 

1.  External  Calcaneo-Astragaloid. 

2.  Posterior  Calcaneo-Astragaloid. 

3.  Interosseous. 

1.  The  External  Calcaneo-Astragaloid  Ligament  is  a  short,  strong 
Fasciculus  passing  from  the  outer  side  of  the  Astragalus  to  the  outer 
surface  of  the  Os  Calcis.     (See  Chart  No.  8.) 

2.  The  Posterior  Calcaneo-Astragaloid  Ligament,  as  its  name 
implies,  is  situated  between  the  two  bones.  (See  Chart  No.  9.)  It 
is  the  chief  bond  of  union  between  the  Astragalus  and  Os  Calcis  and 
unites  these  bones  firmly  together.  The  second  row  has  three  liga- 
ments, namely : 

1.  Dorsal  (or  top  part  of  the  foot). 

2.  Plantar  (or  sole  of  foot). 

3.  Interosseous. 

1.  The  Dorsal  Ligaments  are  so  called  because  they  are  located 
on  the  Dorsal  surface  of  the  foot.     They  are  small  bands  of  parallel 


38 


THE    HUMAN    FOOT 


fibers,  which  pass  from  each  bone  of  the  Tarsus  to  the  neighboring 
bone  with  which  it  articulates. 

2.  The  Plantar  Ligaments  have  the  same  arrangements  as  the 
Dorsal  ligaments,  only  they  are  situated  on  the  Plantar  surface  of 
the  foot. 

3.  The  Interosseous  Ligaments  of  the  Tarsus  are  four  in  number, 
one  between  the  sides  of  the  Scaphoid  and  Cuboid,  a  second  between 
the  Internal  and  Middle  Cuneiform  bones,  a  third  between  the  Middle 
and  External  Cuneiform  bones,  and  a  fourth  between  the  External 


■JJ5TRAGAVJ5 
OS  CALCJ5 


Chart  No.  10 
Cut  Section  of  the  Bones  of  the  Foot  Showing  Interosseous  Ligaments. 


Cuneiform  and  Cuboid  bones.  The  third  row  has  six  ligaments,  four 
ligaments  connecting  the  Os  Calcis  and  Cuboid  together,  and  two 
ligaments  connecting  the  Os  Calcis  and  Scaphoid,  namely: 

1.  Superior  Calcaneo-Cuboid   (on  Dorsal  Surface). 

2.  Internal  Calcaneo-Cuboid  (on  Dorsal  Surface). 

3.  Long  Calcaneo-Cuboid  (on  Plantar  Surface). 

4.  Short  Calcaneo  Cuboid  (on  Plantar  Surface). 

5.  Superior  Calcaneo-Scaphoid. 

6.  Inferior  Calcaneo-Scaphoid. 

1.     The  Superior  Calcaneo-Cuboid  Ligament,  as  the  name  implies, 
is  a  thin  Fasciculus  passing  between  the  contiguous  surfaces  of  the 


THE    LIGAMENTS 


39 

(See 


Os  Calcis  and  Cuboid  bone  on  the  Dorsal  surface  of  the  foot. 
Chart  No.  8.) 

2.     The  Internal  Calcaneo-Cuboid  Ligament  is  a  short,  thick  and 
strong  band  of  fibers  and  forms  one  of  the  chief  bonds  of  union  between 


05CALC15 


SHORT  ) 
CAL-CU5.  > 
LIGAMENT) 

INF.CALCANEO} 
-SCAPHOID  LI& 


SCAPHOID 


INTERNAL 
CUNEIFORM 


LONGCALCANEO 
CUBOID  L1G. 


TEND,  or 

PERONE.US 
L0N6U5. 


Chart  No.  11 
Ligaments  of  the  Sole  of  Right  Foot. 


the  first  and  second  rows  of  the  Tarsus.     It  is  situated  between  the 
Os  Calcis  and  the  Cuboid  internally.     (See  Chart  No.  8.) 

3.     The   Long   Calcaneo-Cuboid  Ligament   is   the   longest   of  all 
ligaments  in  the  Tarsus  and  is  very  superficial.     (See  Chart  No.  11.) 


40  THE    HUMAN    FOOT 

It  is  attached  to  the  under  surface  of  the  Os  Calcis  and  its  fibers  pass 
forward  to  be  attached  to  the  under  surface  of  the  Cuboid  bone,  and 
some  fibers  to  the  second,  third  and  fourth  Metatarsal  bones.  This 
ligament  is  also  called  the  long  Plantar  ligament. 

4.  The  Short  Calcaneo-Cuboid  Ligament  is  short,  being  only  one 
inch  long,  and  very  broad.  It  connects  the  fore  part  of  the  under  sur- 
face of  the  Os  Calcis  to  the  inferior  surface  of  the  Cuboid  bone.  This 
ligament  is  also  known  as  the  short  Plantar  ligament.  (See  Chart 
Xo.   11.) 

5.  The  Superior  Calcaneo-Scaphoid  Ligament  passes  forward  from 
the  inner  side  of  the  anterior  extremity  of  the  Os  Calcis  to  the  outer 
side  of  the  Scaphoid  bone.  (See  Chart  Xo.  8.)  It  is  located  on  the 
Dorsal  surface  of  the  foot. 

6.  The  Inferior  Calcaneo-Scaphoid  Ligament  is  situated  on  the 
Plantar  surface  of  the  foot.  (See  Chart  No.  11.)  It  is  larger  and 
stronger  than  the  foregoing  ligaments,  and  passes  from  the  interior 
and  inner  extremity  of  the  Os  Calcis  to  the  under  surface  of  the 
Scaphoid  bone.  This  concludes  the  ligaments  of  the  Tarsus  proper, 
and  next  in  order  are  the  ligaments  which  connect  the  Tarsal  bones 
with  the  Metatarsal  bones,  called  Tarso-Metatarsal  ligaments. 

TARSO-METATARSAL  LIGAMENTS 

There  are  three  in  number,  namely : 

1.  Dorsal. 

2.  Plantar. 

3.  Interosseous. 

1.  The  Dorsal  Ligaments  consist  of  flat  fibrous  bands  which  con- 
nect the  Tarsal  with  the  Metatarsal  bones,  and  are  situated  on  the 
Dorsal  surface  of  the  foot.  The  first  Metatarsal  bone  is  connected  to 
the  Internal  Cuneiform  by  a  single  broad,  thin  fibrous  band;  the 
second  Metatarsal  bone  has  three  Dorsal  ligaments,  one  from  each 
Cuneiform ;  the  third  Metatarsal  has  one  from  the  external  Cunei- 
form ;  and  the  fourth  and  fifth  Metatarsal  bones  have  one  each  from 
the  Cuboid  bone. 


THE    LIGAMENTS  41 

2.  The  Plantar  Ligaments  consist  of  longitudinal  and  oblique 
bands  connecting  the  Tarsal  with  the  Metatarsal  bones  on  the  Plantar 
surface  of  the  foot.  The  first  and  second  Metatarsals  are  more  promi- 
nent, the  second  and  third  Metatarsals  have  strong  fibers  passing  over 
the  Internal  Cuneiform,  and  the  fourth  and  fifth  Metatarsal  bones  have 
only  a  few  fibers. 

3.  The  Interosseous  Ligaments  are  three  in  number,  namely,  the 
Internal,  Middle  and  External.  The  internal  one  passes  from  the 
outer  extremity  of  the  Internal  Cuneiform  to  the  second  Metatarsal. 
The  middle  one  connects  the  External  Cuneiform  with  the  second 
Metatarsal.  The  external  one  connects  the  External  Cuneiform  with 
the  third  Metatarsal  bone.  Besides  the  above  ligaments  of  the  Tarso- 
Metatarsal  articulations,  there  are  Dorsal,  Plantar  and  Interosseous 
ligaments  of  the  Metatarsal  bones  proper.  The  Dorsal  and  Plantar 
ligaments  pass  from  one  Metatarsal  bone  to  the  other.  (See  Chart 
No.  8.)  The  Interosseous  ligaments  lie  deeply  between  the  lateral 
surfaces  of  the  Metatarsal  bones.  The  digital  extremities  of  the  Meta- 
tarsal bones  are  united  by  the  Transverse  Metatarsal  ligament.  This 
ligament  also  connects  the  great  toe  with  all  the  Metatarsal  bones. 

The  ligaments  to  be  considered  next  are  those  which  connect  the 
Metatarsal  bones  with  the  phalanges  of  the  toes. 

METATARSO-PHALANGEAL  LIGAMENTS 

There  are  three  ligaments  to  each  joint,  one  Plantar  and  two 
Lateral  ligaments. 


Chart  No.  A12 
Lateral   Ligaments,   Metatarsophalangeal  Joint 


1.     The  Plantar  Ligaments  are  thick  fibrous  structures  placed  on 
the  Plantar  surface  of  the  joints  in  the  intervals  between  the  lateral 


42  THE    HUMAN    FOOT 

ligaments,  to  which  they  are  connected.  They  are  attached  to  the 
Metatarsal  bones  and  the  first  phalanges. 

2.  The  Lateral  Ligaments  are  strong  rounded  cords  placed  on  each 
side  of  the  joint,  each  being  attached  by  one  extremity  to  the  Metatar- 
sal bones  and  by  the  other  to  the  first  phalanges.  The  last  of  the 
ligaments  of  the  foot  to  be  described  are  those  of  the  phalanges.  There 
are  three  ligaments  for  each  pair  of  phalanges,  one  Plantar  and 
two  Lateral  ligaments. 

The  arrangements  of  these  ligaments  are  similar  to  those  of  the 
Metatarso-Phalangeal  ligaments  which  were  described  above. 

This  concludes  this  chapter,  and  we  will  next  consider  the  chief 
muscles  and  tendons  of  the  foot. 


CHAPTER    VII 


MUSCLES  AND  TENDONS   OF  THE  LEG 

The  tendons  are  generally  described  in  conjunction  with  the 
muscles,  as  most  of  them  are  contiguous  with  the  muscles. 

Tendons  are  white  fibrous  cords  varying  in  length  and  thickness, 
of  considerable  strength  and  devoid  of  elasticity,  and  have  hardly 
any  blood  vessels.  The  fibers  run  parallel  with  each  other  and  are 
firmly  united  together,  having  the  appearance  of  a  white,  glistening 
cord. 

The  muscles  are  connected  with  the  bones,  ligaments  and  skin 
directly  or  through  the  intervention  of  fibrous  structure  called  tendons. 
Where  the  muscles  are  attached  to  the  bone  the  fibers  terminate  in 
blunt  extremities  upon  the  covering  of  the  bone  called  Periosteum. 
Where  the  muscles  are  connected  with  the  skin  they  either  lie  as  a 
flattened  layer  beneath  the  skin  or  connected  with  connective  tissue. 
The  muscles  vary  extremely  in  their  form ;  they  may  be  long,  short, 
broad,  flat,  round,  etc.  The  arrangement  of  the  fibers  varies  greatly 
in  different  muscles. 

The  muscles  of  the  leg  are  completely  invested  by  the  Deep  Fascia, 
which  is  a  fibrous  structure  investing  the  whole  of  this  region  of 
the  limb,  excluding  the  inner  surface  of  the  Tibia.  It  is  thick  and 
dense  in  the  upper  exterior  part  of  the  leg,  and  gives  attachment 
to  some  of  the  muscles  of  the  leg,  which  we  will  consider  later 
when  we  describe  each  muscle  separately. 

Some  tendons  of  the  muscles  of  the  leg  are  attached  to  the  ankle 
and  foot,  hence  we  must  consider  these  muscles  first  before  we  take 
up  the  muscles  of  the  foot.  For  convenience  I  have  divided  the 
muscles  of  the  leg  into  three  groups,  namely,  the  Anterior,  Posterior 
and  Fibular  groups. 

43 


44  THE    HUMAN    FOOT 

EXTENSOR    MUSCLES    OF    THE    LEG 
Anterior  Group 

This  consists  of  four  muscles  : 

1.  Tibialis  Anticus. 

2.  Extensor  Proprius  Pollicis. 

3.  Extensor  Longus  Digitorum. 

4.  Peroneus  Tertius. 

These  muscles  are  located  on  the  anterior  part  of  the  leg. 

All  anterior  muscles  are  extensors  of  the  leg  and  foot ;  in  other 
words,  they  extend  the  foot,  while  those  on  the  posterior  surface  are 
Flexor  muscles  and,  consequently,  flex  the  foot.  AVe  will  now  de- 
scribe the  above  named  four  muscles : 

1.  The  Tibialis  Anticus,  as  the  name  implies,  is  situated  on  the 
anterior  and  outer  side  of  the  Tibia.  It  arises  from  the  outer  and 
upper  two-thirds  of  the  shaft  of  the  Tibia,  and  from  the  Deep  Fascia 
the  fibers  pass  downward  and  terminate  in  a  tendon  which  is  ap- 
parent on  the  anterior  surface  of  the  muscle  at  the  lower  third  of  the 
leg.  It  is  inserted  into  the  inner  and  under  surfaces  of  the  Internal 
Cuneiform  bone  and  the  base  of  the  Metatarsal  bone  of  the  large  or 
great  toe.     (See  Chart  No.  12.) 

2.  The  Extensor  Proprius  Pollicis. — This  is  the  extensor  muscle 
of  the  large  toe  proper,  as  the  name  implies.  It  is  a  thin,  elongated 
and  flattened  muscle  situated  between  the  Tibialis  Anticus  and  the 
Extensor  Longus  Digitorum,  the  next  muscle  which  we  are  to  con- 
sider. (See  Chart  No.  12.)  It  arises  from  the  anterior  surface  of  the 
Fibula,  about  the  middle  two-fourths  of  its  length.  The  fibers  pass 
downward  and  terminate  in  a  tendon  which  occupies  the  anterior 
border  of  the  muscle,  crosses  the  bend  of  the  ankle  and  is  inserted 
into  the  base  of  the  last  phalanx  of  the  great  toe. 

3.  The  Extensor  Longus  Digitorum. — This  is  the  extensor  muscle 
of  the  other  four  toes,  as  you  will  notice  by  the  following  description. 
It  is  an  elongated,  flattened  muscle  situated  the  most  externally  of  all 
the  muscles  on  the  fore  part  of  the  leg.  (See  Chart  12.)  It  arises 
from  the  upper  part  of  the  Tibia  and  the  upper  three-fourths  of  the 


MUSCLES    AND    TENDONS 


45 


*  I 


i  a 


dirt-1"'"6*31 
W       bone 


V* 


Chart  No.   12 

Anterior  Group  of  Muscles 

of  Leg. 


46  THE    HUMAN    FOOT 

anterior  surface  of  the  shaft  of  the  Fibula,  also  from  the  Deep  Fascia 
and  the  next  muscles,  called  the  Peroneus  Longus  and  Peroneus 
Brevis.  The  fibers  pass  downward  and  terminate  in  a  tendon  which 
again  divides  into  four  slips,  which  run  across  the  dorsum  of  the 
foot,  and  are  inserted  into  the  second  and  third  phalanges  of  the  four 
lesser  toes. 

4.  The  Peroneus  Tertius. — This  muscle  is  a  small  bundle  of  fibers 
and  is  claimed  by  some  authorities  to  be  part  of  the  Extensor  Longus 
Digitorum,  and  may  be  described  as  a  fifth  tendon  of  this  muscle. 
The  fibers  arise  from  the  lower  fourth  of  the  anterior  surface  of  the 
Fibula.  The  tendon  is  inserted  into  the  dorsal  surface  of  the  base 
of  the  Metatarsal  bone  of  the  little  toe  on  the  inner  side. 

POSTERIOR  GROUP 

The  muscles  of  this  group  are  subdivided  into  two  layers,  super- 
ficial and  deep.  The  superficial  layer  constitutes  a  powerful  muscu- 
lar mass  forming  the  calf  of  the  leg. 

Superficial  Layer 
This  consists  of  three  muscles : 

1.  Gastrocnemius. 

2.  Soleus. 

3.  Plantaris. 

1.  The  Gastrocnemius. — The  Gastrocnemius  is  the  most  super- 
ficial muscle,  and  forms  the  greater  part  of  the  calf.  It  arises  by  two 
heads,  which  are  connected  to  the  condyles  of  the  Femur  by  two 
strong  flat  tendons.  The  inner  head  arises  from  the  inner  condyle, 
or  inner  side  of  the  leg,  while  the  external  head  arises  from  the  ex- 
ternal condyle,  or  the  outer  side  of  the  leg.  This  muscle  is  tendinous 
along  the  middle,  and  each  tendon  expands  into  an  aponeurosis  which 
covers  the  posterior  surface  of  that  part  of  the  muscle.  From  the 
anterior  surface  of  these  tendinous  expansions  muscular  fibers  are 
given  off.  The  fibers  continue  downward  and  terminate  with  the 
fibers   of  the   next   muscle  to   be   described,   the   Soleus,   forming  a 


MUSCLES    AND    TENDONS 


47 


HEADS  OF 
GASTROC  NEM1US 


GASTROCNEMIUS 


PERONEUS  LONGUE 
PERONEUS  BREY1S 


FLEXOR  LONGUS 
DIGITORUM 


TENDO  ACHILU5 


Chart  No.   13 

Posterior  Group  of  Muscles  of  Leg, 

Superficial  Layer. 


48 


THE    HUMAN    FOOT 


common  tendon  of  the  two  muscles  called  the'  Tendo-Achillis.  This 
tendon  being  of  vast  importance,  it  will  be  described  separately.  (See 
Chart  No.  13.) 


OUTER 
HEAD 


Chart  No.  14 

Posterior    Group   of   Muscles   of   the 

Leg,  Superficial  L,ayer. 


2.  The  Soleus  is  a  broad  flat  muscle  situated  beneath  the  preced- 
ing muscle.  It  arises  by  tendinous  fibers  from  the  back  part  of  the 
head  of  the  Fibula,  and  from  the  upper  third  of  the  posterior  surface 


MUSCLES    AND    TENDONS  49 

of  its  shaft  and  the  middle  third  of  the  internal  border  of  the  Tibia. 
The  fibers  pass  backward  to  an  aponeurosis  which  covers  the  muscle, 
and  this  gradually  becomes  thicker  and  narrower  and  joins  with  the 
tendon  of  the  Gastrocnemius  to  form  the  Tendo-Achillis.  (See  Chart 
No.  13.)  The  Tendo-Achillis  is  the  thickest  and  strongest  tendon  in 
the  body.  It  is  about  six  inches  in  length,  and  commences  about  the 
middle  of  the  back  of  the  leg,  being  the  common  tendon  of  the  two 
large  muscles  of  the  leg,  namely,  the  Gastrocnemius  and  Soleus,  and 
is  inserted  into  the  lower  part  of  the  posterior  surface  of  the  Os  Calcis. 
(See  Chart  No.  13.)  The  tendon  spreads  out  somewhat  at  its  lower 
end.  This  tendon  can  be  readily  observed  when  standing  on  tip  toes. 
3.  The  Plantaris  is  an  extremely  diminutive  muscle,  placed  be- 
tween the  foregoing  two  muscles,  the  Gastrocnemius  and  Soleus,  and 
has  a  long  and  delicate  tendon.  It  arises  from  a  ridge  on  the  Femur 
and  the  posterior  ligament  of  the  knee  joint,  the  fibers  form  a  small 
fusiform  belly,  about  three  or  four  inches  in  length,  terminating  in  a 
long  slender  tendon  which  crosses  obliquely  the  two  muscles  of  the 
calf  and  running  along  the  inner  border  of  the  Tendo-Achillis,  and 
is  inserted  with  it  into  the  posterior  part  of  the  Os  Calcis.  (See  Chart 
No.  13.)  The  muscles  of  the  calf  possess  great  power,  and  are  con- 
stantly called  into  use  in  standing,  walking,  dancing  and  leaping,  thus 
the  large  size  they  usually  present  when  active. 

Deep  Layer 

This  consists  of  four  muscles : 

1.  Popliteus. 

2.  Flexor  Longus  Pollicis. 

3.  Flexor  Longus  Digitorum. 

4.  Tibialis  Posticus. 

Before  describing  the  above  muscles,  we  must  consider  the  Deep 
Transverse  Fascia  of  :he  leg.  This  is  a  broad  transverse  inter- 
muscular Septum  interposed  between  the  superficial  and  deep  muscles 
of  the  posterior  group.  On  each  side  it  is  attached  to  the  margins 
of  the  Tibia  and  Fibula.     This  Fascia  is  thickened  above  and  below, 


50 


THE    HUMAN    FOOT 


Popliteus 


Soteus 
Tibial  Origin. 

Tibialis 
Posticus 

Flexor Lona  us 
Diqitorum 


TTexorLoncfi/s 
PoJlicis 


Soleus 
■Rbuhv 
OrLain. 


Chart  No.   15 
Deep  Layer  of  Muscles  of  Back  of  Leg. 


MUSCLES   AND    TENDONS  51 

but  in  the  middle  it  is  thin.     It  continues  onward  internally  between 
the  ankle  and  the  heel. 

1.  The  Popliteus  Muscle  is  a  thin,  flat  triangular  muscle.  It  arises 
by  a  strong  flat  tendon,  about  an  inch  in  length,  on  the  outer  side  of 
the  external  condyle  of  the  Femur,  and  is  inserted  into  the  posterior 
surface  of  the  shaft  of  the  Tibia.  Notice  the  triangular  shape  of  the 
muscle  in  the  back  part  of  the  knee  joint  in  Chart  No.  15. 

2.  The  Flexor  Longus  Pollicis  is  situated  on  the  Fibular  side  of 
the  leg,  and  is  the  most  superficial  and  largest  of  the  next  three 
muscles  of  the  leg.  It  arises  from  the  lower  two-thirds  of  the  pos- 
terior surface  of  the  shaft  of  the  Fibula  and  from  the  Fascia.  The 
fibers  pass  obliquely  downward  and  backward  and  terminate  in  a 
round  tendon  which  passes  through  a  groove  on  the  posterior  surface 
of  the  Tibia,  then  through  another  groove  on  the  posterior  surface  of 
the  Astragalus,  and  along  a  third  groove  of  the  Os  Calcis  into  the 
sole  of  the  foot,  where  it  runs  forward  and  is  inserted  into  the  base 
of  the  last  phalanx  of  the  great  toe.  You  can  readily  see  that  the 
action  of  this  muscle  is  to  flex  the  great  toe.  (See  Charts  Nos.  15 
and  17.) 

3.  The  Flexor  Longus  Digitorum  is  situated  on  the  Tibial  side 
of  the  leg.  It  arises  from  the  posterior  surface  of  the  shaft  of  the 
Tibia  and  from  the  Transverse  Fascia,  the  fibers  terminating  in  a 
tendon.  This  tendon  passes  behind  the  Malleolus  through  a  groove, 
and  passes  obliquely  forward  and  outward  beneath  the  arch  of  the 
Os  Calcis  into  the  sole  of  the  foot,  and  finally  divides  into  four  separate 
tendons,  which  are  inserted  into  the  bases  of  the  last  phalanges  of 
the  four  lesser  toes.  Its  action  is,  as  the  description  would  imply, 
to  flex  the  second,  third,  fourth  and  fifth  toes.  (See  Charts  Nos. 
15  and  17.) 

4.  The  Tibialis  Posticus  lies  between  the  two  preceding  muscles, 
and  is  the  most  deeply  seated  of  all  the  muscles  of  the  leg.  It  com- 
mences by  two  pointed  processes  and  arises  from  the  interosseous 
membrane  from  the  posterior  surface  of  the  shaft  of  the  Tibia,  and 
from  the  upper  two-thirds  of  the  internal  surface  of  the  Fibula.  The 
fibers  pass  downward  and  terminate  in  a  tendon  which  passes  through 


52  THE    HUMAN    FOOT 

a  groove  behind  the  inner  Malleolus,  thence  beneath  the  Inferior 
Calcaneo-Scaphoid  ligament,  and  is  inserted  into  the  Scaphoid  and 
internal  Cuneiform  bones.  It  also  gives  off  fibrous  expansions,  one 
of  which  passes  backward  to  the  Os  Calcis,  others  outward  to  the 
Middle  and  External  Cuneiform  and  Cuboid,  and  some  forward  to 
the  bases  of  the  second,  third  and  fourth  Metatarsal  bones.  (See 
Charts  Nos.  15  and  18.)  The  action  of  this  muscle  is  a  direct  extensor 
of  the  Tarsus  upon  the  leg,  and  also  turns  the  sole  of  the  foot  inward 
in  conjunction  with  the  Tibialis  Anticus. 


FIBULAR  GROUP 

This  consists  of  two  muscles : 

1.  Peroneus  Longus. 

2.  Peroneus  Brevis. 

1.  The  Peroneus  Longus  is  situated  at  the  upper  part  of  the  outer 
side  of  the  leg,  and  is  the  more  superficial  of  the  two  muscles.  It 
arises  from  the  head  and  upper  two-thirds  of  the  outer  surface  of  the 
shaft  of  the  Fibula,  from  the  Fascia  and  intermuscular  septum.  It 
terminates  in  a  long  tendon  which  passes  behind  the  outer  Malleolus 
in  a  groove.  It  is  then  reflected  obliquely  across  the  outer  side  of 
the  Os  Calcis ;  then  in  another  groove  on  the  under  surface  of  the 
Cuboid  bone.  It  then  crosses  obliquely  the  sole  of  the  foot,  and  is 
inserted  into  the  outer  side  of  the  base  of  the  Metatarsal  bone  of 
the  great  toe  and  the  Internal  Cuneiform  bone.  Occasionally  it  sends 
a  slip  to  the  base  of  the  second  Metatarsal  bone.  Its  action  is  also  to 
extend  the  foot  upon  the  leg,  just  opposite  to  that  of  the  Tibialis 
Anticus  and  the  Peroneus  Tertius,  which  are  flexors  of  the  foot.  (See 
Charts  Nos.  15  and  A16.) 

2.  Peroneus  Brevis  lies  beneath  the  Peroneus  Longus  and  is 
shorter  and  smaller.  It  arises  from  the  lower  two-thirds  of  the  ex- 
ternal surface  of  the  shaft  of  the  Fibula,  and  from  the  intermuscular 
septum.  The  fibers  pass  vertically  downward  and  terminate  in  a 
tendon  which  runs  in  front  of  that  of  the  preceding  muscle  through 


MUSCLES    AND    TENDONS 


53 


the  same  groove,  behind  the  External  Malleolus ;  it  then  passes  to 
the  outer  side  of  the  Os  Calcis  and  is  finally  inserted  into  the 
dorsal  surface  of  the  base  of  the  Metatarsal  bone  of  the  little  toe  on 
the  outer  side. 


Gastrocnemius, 

Soleus. 
Peroneus  Longus. 

Peroneus  Brevis. 


Annular  Ligament, 


Tibialis  Anticus. 


External 

Annular 
Ligament. 


Tendon  Peroneus  Longus. 

Tendon  Peroneus  Brevis. 

Chart  No.  A16 
External   View   of   Right   Leg,    Showing   the   Peroneus    Longus   and   Brevis. 

From  the  above  it  can  be  seen  that  the  Peroneus  Longus  and 
Brevis  muscles  serve  to  steady  the  leg  upon  the  foot  in  standing 
upon  one  foot.     (See  Charts  Nos.  15  and  A16.) 


CHAPTER   VIII 


MUSCLES  AND  TENDONS  OF  THE  FOOT 

Under  this  chapter  we  are  to  consider  the  muscles  and  tendons 
of  the  foot,  and  in  this  connection  I  must  call  your  attention  to  four 
structures  which  we  find  in  the  foot  and  which  are  closely  related  to 
the  muscles  and  tendons  and  will  be  described  separately.  They 
are  the 

1.  Anterior  Annular  ligament. 

2.  Internal  Annular  ligament. 

3.  External  Annular  ligament. 

4.  Plantar   Fascia. 

1.  The  Anterior  Annular  Ligament  consists  of  a  superior  or  ver- 
tical portion  which  binds  down  the  extensor  tendons  as  they  descend 
on  the  front  of  the  Tibia  and  Fibula,  and  an  inferior  or  horizontal 
portion  which  retains  the  tendons  in  connection  with  the  Tarsus. 
The  vertical  portion  is  attached  externally  to  the  lower  end  of  the 
Fibula,  internally  to  the  Tibia  and  above  is  continuous  with  the 
fascia  of  the  leg.  The  horizontal  portion  is  attached  externally  to 
the  upper  surface  of  the  Os  Calcis.  It  passes  upward  and  inward 
as  a  double  layer,  one  layer  passing  in  front  and  the  other  behind  the 
Peroneus  Tertius  and  Extensor  Longus  Digitorum.  Later  the  two 
layers  join  together,  forming  a  sort  of  a  loop  in  which  the  tendons 
are  enclosed.  From  the  inner  extremity  of  this  loop  two  bands  of 
fibers  are  given  off,  one  passing  upward  and  inward  to  be  attached  to 
the  Internal  Malleolus,  the  other  passing  downward  and  inward  to 
be  attached  to  the  Plantar  Fascia.  This  ligament  is  a  very  important 
structure  of  the  ankle  joint,  as  you  will  notice  by  referring  to  Chart 
No.  12  and  Chart  No.  A16. 

2.  The  Internal  Annular  Ligament  is  a  strong  fibrous  band  which 
extends  from  the  inner  Malleolus  above  to  the  inner  margin  of  the  Os 

54 


MUSCLES    AND    TEXDOXS 


55 


Calcis  below,  converting  a  series  of  grooves  in  this  situation  into  canals 
for  the  passage  of  the  tendons  of  the  flexor  muscles  into  the  sole  of 
the  foot.  It  is  continuous  above  with  the  Deep  Fascia  of  the  leg  and 
by  its  lower  border  with  the  Plantar  Fascia. 

3.     The  External  Annular  Ligament  extends  from  the  outer  Mal- 
leolus to  the  outer  surface  of  the  Os  Calcis  and  is  a  shorter  fibrous 


Branches  of  Internal 
Plantar  Nerve. 


Inner  Portion  of 

Plantar  Fascia.  — ts=?S* 

Thick  Central  Portion 
of  Plantar  Fascia. 

Inner  Portion  of 
Plantar  Fascia. 


Connective   Tissue   and   Fat 
wr~in  the  Web  of  the  Toes. 


uperficial  Transverse 
Metatarsal  Ligament. 

Branches  of  External 
Plantar  Xerve. 


Outer  Portion  of 
Plantar   Fascia. 


Branches  of  External 
Plantar  Xerve. 


Outer  Portion  of 
Plantar  Fascia. 


Calcaneo-Metatarsal 
Ligament. 


Chart  Xo.  B16 
The  Plantar  Fascia  and  Plantar  Cutaneous  Xerves. 


structure  which  binds  down  the  tendons  of  Peronei  muscles.      (See 
Chart  Xo.  A16.) 

4.  The  Plantar  Fascia  is  the  densest  of  all  the  fibrous  membranes. 
It  is  of  great  strength  and  consists  of  dense  pearly-white  fibers 
disposed  for  the  most  part  longitudinally.  It  is  divided  into  a  central 
and  two  lateral  portions,  namely,  the  outer  and  inner  portions.  The 
central  portion  is  the  thickest,  is  narrow  behind  and  attached  to  the 


56  THE    HUMAN    FOOT 

inner  tubercle  of  the  Os  Calcis,  becomes  broader  and  thinner  in  front 
and  divides  near  the  heads  of  the  Metatarsal  bones  into  five  processes, 
one  for  each  toe.  Each  of  these  processes  again  subdivides  into  two, 
opposite  the  Metatarso-Phalangeal  joints,  a  superficial  and  a  deep. 
The  superficial  one  is  inserted  into  the  skin.  The  deep  divides  into 
two  slips  which  embrace  the  sides  of  the  flexor  tendons  of  the  toes 
and  laterally  with  the  Transverse  Metatarsal  ligaments,  thus  form- 
ing a  series  of  arches  through  which  the  tendons  of  the  short  and 
long  flexor  muscles  pass  to  the  toes. 

The  Central  Portion  of  this  Fascia  is  continuous  with  the  lateral 
portion  on  each  side  and  sends  off  several  septums  upward  into  the 
foot. 

The  Outer  Portion  covers  the  under  surface  of  the  Abductor 
Minimi  Digiti  muscle,  which  will  be  described  later.  It  is  thick  be- 
hind and  thin  in  front,  and  extends  from  the  Os  Calcis  forward  to 
the  base  of  the  fifth  Metatarsal  bone  where  it  is  attached  to  its  outer 
side.  It  is  continuous  internally  with  the  middle  portion  of  the 
Plantar  Fascia  and  externally  with  the  Dorsal  Fascia. 

The  Inner  Portion  is  very  thin  and  covers  the  Abductor  Pollicis 
muscle,  another  muscle  which  will  be  described  later.  It  is  attached 
behind  to  the  Internal  Annular  ligament  and  is  continuous  around  the 
side  of  the  foot  with  the  Dorsal  Fascia  and  externally  with  the  middle 
portion  of  the  Plantar  Fascia. 

We  will  now  describe  the  muscles  of  the  foot,  and  for  your  con- 
venience I  have  divided  these  muscles  into  two  main  groups,  namely: 

1.  The  muscles  of  the  Dorsum  of  the  foot. 

2.  The  muscles  of  the  Plantar  surface  of  the  foot. 

DORSAL    REGION 

1.     The  Dorsal  Region  has  one  muscle,  namely: 

The  Extensor  Brevis  Digitorum. — It  is  -a  broad,  thin  muscle  which 

arises  from  the  outer  side  of  the  Os  Calcis  from  the  External  Calcaneo- 

Astragaloid  ligament  and  from  the  horizontal  portion  of  the  Anterior 

Annular  ligament.    It  passes  obliquely  across  the  Dorsum  of  the  foot 


MUSCLES    AXD    TEXDOXS 


57 


and  terminates  in  four  tendons.  The  innermost,  which  is  the  largest 
of  the  four  tendons,  is  inserted  into  the  first  phalanx  of  the  great 
toe;  the  other  three  are  inserted  into  the  outer  sides  of  the  long 
extensor  tendons  of  the  second,  third  and  fourth  toes.  (See  Charts 
Nos.  12  and  C16.) 


INTERNAL  BRANCH  OF 
ANT.TIBIAL  NERVE 

fEXTENSOR 
{BREVIS 

[digitorum 


THE  4  DORSAL  INTEROSSEI  MUSCLES 


Chart  No.   CI 6 

Showing  the   Extensor   Brevis   Digitorum   and   Its   Insertion. 


PLANTAR  REGION 

2.  The  Plantar  Region  is  divided  into  four  layers,  and  each  layer 
consists  of  several  muscles.  We  will  therefore  describe  these  muscles 
under  their  respective  layers. 


FIRST    LAYER 

This  consists  of  three  muscles,  namely  : 

1.  Abductor  Pollicis. 

2.  Flexor  Brevis  Digitorum. 

3.  Abductor   Minimi   Dio-iti. 


58 


THE    HUMAN    FOOT 


1.  The  Abductor  Pollicis  lies  along  the  inner  border  of  the  foot. 
It  arises  from  the  under  surface  of  the  Os  Calcis  from  the  Internal 
Annular  ligament,  from  the  Plantar  Fascia  and  from  the  Intermuscu- 
lar Septum.    The  fibers  terminate  in  a  tendon  and  are  inserted  together 


Os  Calcis 


FLEXOR  BREVIS 
DiGlTORUf> 


Chart  No.  16 

Muscles  of  the  Sole  of  the  Foot, 

First  Layer. 

with  the  innermost  tendon  of  the  Flexor  Brevis  Pollicis  into  the  inner 
side  of  the  base  of  the  first  phalanx  of  the  great  toe.  (See  Chart 
No.  16.) 

2.     The  Flexor  Brevis   Digitorum  lies  in  the  middle  of  the  sole 
of  the  foot,  immediately  beneath  the  Plantar  Fascia  with  which  it  is 


MUSCLES    AND    TENDONS  59 

firmly  united.  It  arises  from  the  under  surface  of  the  Os  Calcis, 
from  the  central  part  of  the  Plantar  Fascia  and  from  the  Intermuscular 
Septum ;  it  then  passes  forward  and  is  divided  into  four  tendons, 
which  are  inserted  into  the  four  lesser  toes.  Opposite  the  middle  of 
the  first  Phalanx  of  each  toe  the  tendon  presents  a  longitudinal  slit 
to  allow  the  passage  of  the  corresponding  tendon  of  the  Flexor 
Longus  Digitorum ;  the  tendon  of  the  Flexor  Brevis  Digitorum  then 
reunites  and  again  divides  into  two  processes,  which  are  inserted 
into  the  sides  of  the  second  Phalanges  of  the  four  lesser  toes.  (See 
Chart  No.  16.) 

3.  The  Abductor  Minimi  Digiti  lies  along  the  outer  border  of 
the  foot.  It  arises  by  a  very  broad  origin  from  the  under  surface  of 
the  Os  Calcis,  from  the  Plantar  Fascia  and  from  the  Intermuscular 
Septum,  and  terminates  in  a  tendon  which  is  inserted,  together  with 
the  tendon  of  the  Flexor  Brevis  Digitorum  of  the  little  toe,  into  the 
outer  side  of  the  base  of  the  first  Phalanx  of  the  little  toe.  (See 
Chart  No.  16.) 

SECOND    LAYER 

This  layer  has  five  muscles,  namely: 

1.  Flexor  Accessorius. 

2.  Lumbricales   (four  in  number). 

1.  The  Flexor  Accessorius  arises  by  two  heads,  the  inner  or 
larger  head  being  attached  to  the  inner  surface  of  the  Os  Calcis  and 
to  the  Calcaneo-Scaphoid  ligament.  The  outer  head  is  flat  and 
tendinous  and  is  attached  to  the  under  surface  of  the  Os  Calcis  and 
to  the  long  Plantar  ligament.  The  two  heads  join  at  an  acute  angle 
and  are  inserted  into  the  outer  margin  and  the  upper  and  under  sur- 
faces of  the  tendon  of  the  Flexor  Longus  Digitorum.  (See  Chart 
No.  17.) 

2.  The  Lumbricales  are  four  small  muscles,  accessory  to  the  ten- 
dons of  the  Flexor  Longus  Digitorum.  They  arise  from  the  tendons 
of  the  long  Flexor  as  far  back  as  their  angle  of  division,  each  arising 
from  two  tendons  of  the  long  Flexor,  except  the  internal  one.     Each 


60 


THE    HUMAN    FOOT 


muscle  terminates  in  a  tendon  which  passes  forward  on  the  inner  side 
of  each  of  the  lesser  toes  and  is  inserted  into  the  long  Extensor 
and  base  of  the  first  Phalanx  of  the  corresponding  toe. 


Chart  No.  17 

Muscles  of  the  Sole  of  the   Foot, 

Second  Layer. 


THIRD  LAYER 

This  layer  has  four  muscles,  namely: 

1.  Flexor  Brevis  Pollicis. 

2.  Adductor  Pollicis. 

3.  Flexor  Brevis  Minimi  Digiti. 

4.  Transversus   Pedis. 


MUSCLES    AND    TENDONS 


61 


1.  The  Flexor  Brevis  Pollicis  arises  by  a  pointed  tendinous  process 
from  the  inner  border  of  the  Cuboid  bone,  from  the  External  Cuneiform 
bone  and  from  the  prolongation  of  the  tendon  of  the  Tibialis  Posticus. 
The  muscle  divides  into  two  portions  which  are  inserted  as  follows : 


Chart  No.  18 
Muscles  of  Sole  of  the  Foot,  Third  Layer. 


One  on  the  inner  side  of  the  base  of  the  first  phalanx  of  the  great 
toes,  blended  together  with  the  Abductor  Pollicis;  the  other  portion 
is  inserted  into  the  outer  side  of  the  first  Phalanx  of  the  great  toe 


62  THE    HUMAN    FOOT 

and  blended  together  with  the  Adductor  Pollicis  and  the  tendon  of  the 
Flexor  Longus  Pollicis.     (See  Chart  Xo.  18.) 

2.  The  Adductor  Pollicis  is  a  large,  thick,  fleshy  muscle  passing 
obliquely  across  the  foot  and  occupying  the  hollow  space  between 
the  four  inner  Metatarsal  bones.  It  arises  from  the  Tarsal  extremities 
of  the  second,  third  and  fourth  Metatarsal  bones  and  from  the  tendon 
of  the  Peroneus  Longus  and  is  inserted,  together  with  outer  portion 
of  the  Flexor  Brevis  Pollicis,  into  the  outer  side  of  the  base  of  the 
first  Phalanx  of  the  great  toe.     (See  Chart  No.  18.) 

3.  The  Flexor  Brevis  Minimi  Digiti  lies  on  the  Metatarsal  bone 
of  the  little  toe  and  arises  from  the  base  of  that  bone  and  from  the 
Peroneus  Longus,  and  is  inserted  into  the  base  of  the  first  Phalanx 
of  the  little  toe  on  its  outer  side.     (See  Chart  Xo.  18.) 

4.  The  Transversus  Pedis  is  a  narrow,  flat  muscular  fasciculus 
stretched  transversely  across  the  heads  of  the  Metatarsal  bones.  It 
arises  from  the  under  surface  of  the  head  of  the  fifth  Metatarsal  bone 
and  from  the  Transverse  ligament  of  the  Metatarsus  and  is  inserted 
on  the  outer  side  of  the  first  Phalanx  of  the  great  toe.  Its  fibers  blend 
with  the  tendon  of  the  Adductor  Pollicis.  The  action  of  the  Trans- 
versus Pedis  increases  the  arching  of  the  foot  and  abducts  the  great 
toe.     (See  Chart  Xo.  18.) 

FOURTH    LAYER 

This  layer  consists  of  seven  Interossei  muscles.  There  are  four 
in  the  Dorsum  of  the  foot  and  three  in  the  Plantar  surface. 

The  Dorsal  Interossei  are  four  in  number  and  are  situated  between 
the  Metatarsal  bones.  They  arise  by  two  heads  from  the  adjacent  sides 
of  the  Metatarsal  bones ;  their  tendons  are  inserted  into  the  bases  of 
the  first  Phalanges  of  the  middle  three  lesser  toes  and  into  the  com- 
mon Extensor  tendon.  The  first  Dorsal  Interosseous  muscle  is  in- 
serted into  the  outer  sides  of  the  second  toe  ;  the  other  three  are  inserted 
into  the  inner  side  of  the  second,  third  and  fourth  toes.  (See  Chart 
Xo.   19.) 

The  Plantar  Interossei,  three   in  number,   lie  beneath   the   third, 


MUSCLES    AND    TENDONS 


63 


fourth  and  fifth  Metatarsal  bones.  They  are  single  muscles  and  arise 
from  the  base  and  the  shaft  of  their  respective  Metatarsal  bones,  and 
are  inserted  into  the  inner  sides  of  the  bases  of  the  first  Phalanges  of 
the  same  toes  and  into  the  common  Extensor  tendon.  (See  Chart 
No.  20.)  All  the  muscles  of  the  foot  act  upon  the  toes,  and  for  the 
purpose  of  description  as  regards  their  action  may  be  grouped  as 
Abductors,    Adductors,    Flexors    or    Extensors.     And,    whereas    the 


■ith- DORSAL 

SA/ZCAOSSri 


Chart  No.  19 
The    Dorsal    Interossei    Mus- 
cles  (Left  Foot),  Fourth 
L,ayer. 


muscles  of  the  foot  are  of  prime  importance  in  your  work,  it  is  well 
that  I  give  you  an  idea  of  the  function  of  each  muscle. 

The  Abductors  are  the  Dorsal  Interossei,  the  Abductor  Pollicis 
and  the  Abductor  Minimi  Digiti.  The  first  Dorsal  Interosseous 
muscle  draws  the  second  toe  inward  toward  the  great  toe;  the  second 
muscle   draws  the  same  toe  outward.     The  third   muscle  draws  the 


64 


THE    HUMAN    FOOT 


third  toe  and  the  fourth  muscle  draws  the  fourth  toe  in  the  same 
direction ;  they  also  flex  the  proximal  Phalanges  and  extend  the  two 
terminal  Phalanges.  The  Abductor  Pollicis  abducts  the  great  toe 
from  the  other  toes  and  also  flexes  the  proximal  Phalanx  of  the  great 
toe.  The  Abductor  Minimi  Digiti  acts  in  the  same  manner  on  the 
little  toe. 

The  Adductors  are  the  Plantar  Interossei,  the  Adductor   Pollicis 


J* PLANTAR 
JNTSROSSET 


3  is 


Chart  No.  20 

The  Plantar  Interossei 

(Left  Foot). 


and  the  Transversus  Pedis.  The  Plantar  Interosseous  muscles  draw 
the  third,  fourth  and  fifth  toes  toward  the  second  toe,  also  flex  the 
proximal  Phalanges  and  extend  the  two  terminal  Phalanges.  The 
Adductor  Pollicis  adducts  the  great  toe  toward  the  second  toe  and 
also  assists  in  flexing  this  toe.  The  Transversus  Pedis  approximates 
all  the  toes  and  thus  increases  the  curve  of  the  Transverse  Arch  of 
the  Metatarsus. 


MUSCLES    AND    TENDONS  65 

The  Flexors  are  the  Flexor  Brevis  Digitorum,  the  Flexor  Acces- 
sorius,  the  Flexor  Brevis  Pollicis,  the  Flexor  Brevis  Minimi  Digiti 
and  the  Lumbricales.  The  Flexor  Brevis  Digitorum  flexes  the  second 
Phalanges  upon  the  first  and  brings  the  toes  together.  The  Flexor 
Accessorius  assists  the  long  flexor  of  the  toes  and  converts  the  oblique 
pull  of  the  tendon  of  that  muscle  into  a  direct  backward  pull  upon 
the  toes.  The  Flexor  Brevis  Minimi  Digiti  flexes  the  little  toe  and 
draws  its  Metatarsal  bone  downward  and  inward.  The  Lumbricales 
assist  in  flexing  the  proximal  Phalanges  and,  by  their  insertion  into 
the  long  Extensor  tendon,  aid  in  straightening  the  two  terminal 
Phalanges. 

The  Extensors. — In  this  group  there  is  only  one,  the  Extensor 
Brevis  Digitorum.  It  extends  the  first  Phalanx  of  the  great  toe  and 
assists  the  long  Extensor  in  extending  the  next  three  toes ;  it  also 
gives  to  the  toes  an  outward  direction  when  extended.  This  con- 
cludes the  description  of  the  muscles  and  tendons  of  the  leg,  ankle 
and  foot,  and  before  giving  you  the  arteries,  veins  and  nerves  it  would 
be  advisable  to  study  these  muscles  again  by  comparing  them  with 
the  charts  given  in  this  book  and  master  them  thoroughly,  as  they 
are  of  vital  importance  in  malformations  of  the  foot. 


CHAPTER    IX 


THE   ARTERIES   OF   THE   FOOT 

Under  Chapter  Y  I  gave  you  a  general  description  of  the  struc- 
ture of  the  arteries,  also  the  mode  of  distributions,  and  now  we  are 
to  describe  each  artery  and  branch  of  the  leg  and  foot  separately. 
Before  we  can  comprehend  the  origin  and  division  of  these  arteries, 
I  must  refer  you  back  to  Chapter  V,  in  which  you  will  find  a  descrip- 
tion of  the  circulation  of  the  blood. 

The  blood  is  forced  through  the  large  vessels  by  the  heart,  which 
acts  as  a  pump.  These  vessels  or  arteries  have  branches  and  capillaries. 
It  is  not  necessary  to  consider  all  the  arteries  of  the  body  in  this  book, 
as  we  are  only  interested  in  those  vessels  which  distribute  the  blood 
supply  to  the  lower  limb  and  foot.  For  this  reason  we  will  commence 
at  the  knee  joint  and  go  down.  The  first  artery  to  be  considered  is 
the  Popliteal  artery,  which  is  a  continuation  of  the  largest  artery  in 
the  thigh,  namely,  the  Femoral  artery. 

The  Popliteal  Artery  commences  at  the  junction  of  the  middle 
and  lower  third  of  the  thigh,  and  passes  obliquely  downward  and 
outward  behind  the  knee  joint  to  the  lower  border  of  the  Popliteus 
muscle,  where  it  divides  into  the  Anterior  and  Posterior  Tibial  arteries. 
(See  Charts  Nos.  21  and  22.)  This  brings  us  down  to  the  arteries 
of  the  leg  proper.  The  arteries  of  the  leg  are  divided  into  two  main 
arteries  and  their  branches,  which  will  be  described  under  their  re- 
spective headings,  namely,  the  Anterior  Tibial  artery  and  the  Posterior 
Tibial  artery. 

The  Anterior  Tibial  Artery  commences  at  the  bifurcation  of  the 
Popliteal  artery  at  the  lower  border  of  the  Popliteus  muscle,  passes 
forward  between  the  two  heads  of  the  Tibialis  Posticus  muscle  and 
through  an  aperture  left  between  the  bones  to  the  deep  part  of  the 
front  of  the  leg;  it  then  descends  on  the  anterior  aspect  of  the  Tibia 

66 


THE    ARTERIES 


67 


POPLITEAL 
ARTERY 

GASTHDC 
N£N/i/J 
PIANT 


F0FL1IEU5 


SOLEUS 
TIBIAL 
OKIGJN 


POSTERIOR 
TIBIAL 
ARTERY 


fWCQR 

IOMGUS 
DIG. 


Chart  No.  21 

The  Popliteal,  Posterior  Tibial  and 

Peroneal  Arteries. 


68  THE    HUMAN    FOOT 

to  the  bend  of  the  ankle  joint,  where  it  lies  more  superficially  and 
becomes  the  Dorsalis  Pedis  artery.  (See  Chart  Xo.  22.)  The  Anterior 
Tibial  artery  is  accompanied  by  two  veins,  called  venae  comites, 
which  lie  one  on  either  side  of  the  artery.  The  Anterior  Tibial  nerve 
lies  at  first  to  its  outer  side,  and  about  the  middle  of  the  leg  is  placed 
superficially  to  it. 

At  the  lower  part  of  the  artery  the  nerve  again  is  on  the  outer  side. 
The  Anterior  Tibial  artery  is  divided  into  four  branches,  namely: 

1.  Recurrent  Tibial. 

2.  Muscular. 

3.  Internal  Malleolar. 

4.  External  Malleolar. 

1.  The  Recurrent  Tibial  Branch  arises  from  the  Anterior  Tibial 
artery  as  soon  as  that  vessel  has  passed  through  the  aperture  about 
the  knee  joint.  It  ascends  in  the  Tibialis  Anticus  muscle  and  ramifies 
on  the  front  and  sides  of  the  knee  joint,  anastomosing  with  the  articu- 
lar branches  of  the  Popliteal  and  the  Anastomotica  Magna.  (See  Chart 
Xo.  22.) 

2.  The  Muscular  Branches  are  numerous.  They  are  distributed  to 
the  muscles  which  lie  on  either  side  of  the  vessels,  some  piercing  the 
Deep  Fascia  to  supply  the  Integument,  others  passing  through  the 
Interosseous  membrane  and  anastomosing  with  the  branches  of  the 
Posterior  Tibial  and  Peroneal  arteries.  The  Malleolar  arteries  supply 
the  ankle  joint. 

3.  The  Internal  Malleolar  Branch  arises  about  two  inches  above 
the  ankle  joint  and  passes  beneath  the  tendons  of  the  Extensor 
Proprius  Pollicis  and  Tibialis  Anticus  to  the  inner  ankle,  upon  which 
it  ramifies,  anastomosing  with  branches  of  the  Posterior  Tibial  and 
Internal  Plantar  arteries  and  with  the  Internal  Calcanean  branch  of 
the  Posterior  Tibial  artery.     (See  Chart  No.  22.) 

4.  The  External  Malleolar  Branch  passes  beneath  the  tendons  of 
the  Extensor  Longus  Digitorum  and  Peroneus  Tertius  and  supplies 
the  outer  ankle,  anastomosing  with  the  Anterior  Peroneal  artery  and 
with    ascending   branches    from    the   Tarsal   branch    of   the    Dorsalis 


THE    ARTERIES 


69 


Chart  No.  22 

The  Anterior  Tibial  and  Dorsalis 

Pedis  Arteries. 


70  THE    HUMAN    FOOT 

Pedis.  (See  Chart  No.  22.)  To  facilitate  the  study  of  the  arteries 
of  the  leg"  and  foot,  it  is  necessary  that  I  describe  the  Dorsalis  Pedis 
artery  and  its  branches  before  we  take  tip  the  Posterior  Tibial  artery 
and  its  branches,  as  the  Dorsalis  Pedis  is  a  continuation  of  the  An- 
terior Tibial  artery  which  was  just  described. 

THE  DORSALIS  PEDIS  ARTERY 

Commences  at  the  bend  of  the  ankle  as  a  continuation  of  the 
Anterior  Tibial  artery  and  passes  along  the  Tibial  side  of  the  foot 
to  the  back  part  of  the  first  Interosseous  space,  where  it  divides 
into  five  branches,  namely :     (See  Chart  No.  22.) 

Branches  of  the  Dcrsalis  Pedis  Artery 

1.  Tarsal. 

2.  Metatarsal. 

3.  Interosseous. 

4.  Dorsalis  Pollicis. 

5.  Communicating. 

1.  The  Tarsal  Branch  arises  from  the  Dorsalis  Pedis  as  that  vessel 
crosses  the  Scaphoid  bone.  It  passes  outward,  lying  upon  the  Tarsal 
bones  and  is  covered  by  the  Extensor  Brevis  Digitorum.  It  supplies 
that  muscle  and  the  Tarsus  and  anastomoses  with  the  branches  of 
the  Metatarsal,  External  Malleolar,  Peroneal  and  External  Plantar 
arteries.     (See  Charts  Nos.  22  and  A23.) 

2.  The  Metatarsal  Branch  arises  a  little  anterior  to  the  preceding, 
and  passes  outward  to  the  outer  part  of  the  foot  over  the  bases  of 
the  Metatarsal  bones  beneath  the  tendon  of  the  short  Extensor.  It 
anastomoses  with  the  Tarsal  and  External  Plantar  arteries.  It  gives 
off  three  branches,  the  Interosseous.     (See  Charts  Nos.  22  and  A23.) 

3.  The  Interosseous  Branches  are  three  in  number,  passing  for- 
ward upon  the  three  outer  Dorsal  Interossei  muscles  and  between 
the  toes  and  divides  into  two  collateral  Dorsal  branches  for  the  ad- 
joining toes.  At  the  back  part  these  vessels  receive  the  Posterior 
Perforating  branches  from  the  Plantar  arch  and  at  the  fore  part  they 


THE    ARTERIES 


71 


Peroneus  Brevis. 

Extensor  Longus 
Digitorum. 

Anterior  Peroneal 

Artery. 

External  Malleolar 

Artery. 


Extensor   Brevis 
Digitorum. 


Tarsal  Artery 


Metatarsal  Artery. 


Dorsal   Interosseous 
Arteries. 


Anterior   Tibial    Artery. 

Extensor  Eongus 
Hallucis. 
Tibialis  Anticus. 

Internal   Malleolar 
Artery. 


Dorsalis   Pedis 
Artery. 


Dorsalis  Pollicis 
Artery. 


Chart    No.    A23 

The  Dorsalis  Pedis  Artery  and  Its  Branches. 


72  THE    HUMAN    FOOT 

are  joined  by  the  Anterior  Perforating  branches  from  the  Plantar 
arch,  the  outermost  Interosseous  artery  sending-  off  an  additional 
branch,  which  supplies  the  outer  side  of  the  little  toe.  (See  Chart 
Xo.  A23.) 

4.  The  Dorsalis  Pollicis  runs  along  the  outer  border  of  the  first 
Metatarsal  bone  and  between  the  first  and  second  toes  and  again 
divides  into  two  branches,  one  of  which  passes  inward  beneath  the 
tendon  of  the  Extensor  Proprius  Pollicis  and  is  distributed  to  the 
inner  border  of  the  great  toe.  The  outer  branch  bifurcates  to  supply 
the  adjoining  sides  of  the  great  and  second  toes.     (See  Chart  Xo.  A23.) 

5.  The  Communicating  Branch  dips  down  into  the  sole  of  the 
foot  between  the  two  heads  of  the  first  Dorsal  Interosseous  muscle 
and  communicates  with  the  termination  of  the  External  Plantar  artery 
to  complete  the  Plantar  arch.  It  here  gives  off  two  digital  branches : 
one  runs  along  the  inner  side  of  the  great  toe  on  its  Plantar  surface, 
the  other  forward  along  the  first  Interosseous  space  and  bifurcates 
for  the  supply  of  the  adjacent  sides  of  the  great  and  second  toes. 
(See  Chart  Xo.  22.) 

THE    POSTERIOR    TIBIAL    ARTERY 

Is  of  large  size,  which  extends  obliquely  downward  from  the 
lower  border  of  the  Popliteus  muscle  along  the  Tibial  side  of  the 
leg  to  the  Fossa  between  the  inner  ankle  and  the  heel,  where  it  divides 
into  the  Internal  Plantar  and  External  Plantar  arteries.  It  lies  upon 
the  Tibialis  Posticus  and  Flexor  Digitorum  muscles  and  on  the  Tibia 
and  back  part  of  the  ankle,  joint  at  its  lower  part,  running  parallel 
with  the  Tendo-Achillis.  It  is  accompanied  by  two  veins  and  the 
Posterior  Tibial  nerve.  (See  Chart  Xo.  21.)  The  branches  of  the 
Posterior  Tibial  artery  are  divided  as  follows : 

1.  The  Peroneal. 

2.  Anterior  Peroneal. 

3.  Muscular. 

4.  Xutrient. 

5.  Communicating. 

6.  Internal  Calcanean. 


THE    ARTERIES  73 

1.  The  Peroneal  Artery  lies  deeply  seated  along  the  back  part  of 
the  Fibular  side  of  the  leg.  It  arises  from  the  Posterior  Tibial  artery 
an  inch  below  the  lower  border  of  the  Popliteus  muscle,  passes  ob- 
liquely outward  to  the  Fibula  and  then  descends  along  the  inner 
border  of  that  bone  through  the  fibers  of  the  Flexor  Longus  Pollicis 
to  the  lower  third  of  the  leg,  where  it  gives  off  the  Anterior  Peroneal 
branch.  It  then  passes  across  the  articulation  between  the  Tibia  and 
Fibula  to  the  outer  side  of  the  Os  Calcis,  supplying  the  neighboring 
muscles  and  back  of  the  ankle.  It  anastomoses  with  the  External 
Malleolar,  Tarsal  and  External  Plantar  arteries.  The  Peroneal  artery 
in  its  course  gives  off  branches  to  the  Soleus,  Tibialis  Posticus, 
Flexor  Longus  Pollicis,  Peronei  muscles  and  a  nutrient  branch  to 
the  Fibula.     (See  Chart  Xo.  21.) 

2.  The  Anterior  Peroneal  Branch  pierces  the  Interosseous  mem- 
brane about  two  inches  above  the  External  Malleolus  to  reach  the 
fore  part  of  the  leg,  and  passing  down  beneath  the  Peroneus  Tertius 
to  the  outer  ankle  ramifies  on  the  front  and  outer  side  of  the  Tarsus, 
anastomosing  with  the  External  Malleolar  and  Tarsal  arteries.  (See 
Chart  No.  22.) 

3.  The  Muscular  Branches  of  the  Posterior  Tibial  are  distributed 
to  the  Soleus  and  deep  muscles  along  the  back  of  the  leg. 

4.  The  Nutrient  Branch  arises  from  the  Posterior  Tibial,  near  its 
origin,  and  after  supplying  a  few  muscular  branches  enters  the 
nutrient  canal  of  the  Tibia  which  it  traverses  obliquely  from  above 
downward.     This  is  the  largest  nutrient  artery  of  bone  in  the  body. 

5.  The  Communicating  Branch  to  the  Peroneal  runs  transversely 
across  the  back  of  the  Tibia  about  two  inches  above  its  lower  end, 
passing  beneath  the  Flexor  Longus  Pollicis.     (See  Chart  No.  23.) 

6.  The  Internal  Calcanean  are  several  large  arteries  which  arise 
from  the  Posterior  Tibial  just  before  its  division ;  they  are  distributed 
to  the  fat  and  integument  behind  the  Tendo-Achillis  and  about  the 
heel,  also  to  the  muscles  on  the  inner  side  of  the  sole,  anastomosing 
with  the  Peroneal  and  Internal  Malleolar  arteries.    (See  Chart  No.  21.) 


74 


THE  HUMAN  FOOT 


THE  INTERNAL  PLANTAR  ARTERY 

Is  the  smaller  of  the  two  Plantar  arteries  and  passes  along-  the 
inner  side  of  the  foot.  It  is  first  situated  above  the  Abductor  Pollicis 
and  then  between  it  and  the  Flexor  Brevis  Digitorum,  both  of  which  it 
supplies.  At  the  base  of  the  first  Metatarsal  bone  it  passes  along  the 
inner  border  of  the  great  toe.     (See  Charts  Xos.  23  and  24.) 


cotmvmcATM 

BRANCH  OP 
D0XMISJ£D15\ 


Chart  No.  23 
The  Plantar  Arteries.     (Deep  View) 


THE  EXTERNAL  PLANTAR  ARTERY 

Is  much  larger  than  the  Internal,  passes  obliquely  outward  and 
forward  to  the  base  of  the  fifth  Metatarsal  bone ;  it  then  turns  inward 
between  the  bases  of  the  first  and  second  Metatarsal  bones,  where 
it  anastomoses  with  the  communicating  branch  of  the  Dorsalis  Pedis 
artery,  thus  completing  the  Plantar  arch  at  its  commencement.     It  is 


THE    ARTERIES 


75 


placed  between  the  Os  Calcis  and  Abductor  Pollicis,  then  between 
the  Flexor  Brevis  Digitorum  and  Flexor  Accessorius;  as  it  passes  on 
to  the  little  toe,  it  lies  between  the  Flexor  Brevis  Digitorum  and 
Abductor  Minimi  Digiti.  The  remainder  of  the  artery  extends  from 
the  base  of  the  Metatarsal  bone  of  the  little  toe  to  the  back  part  of 
the  first  Interosseous  space  and  forms  the  Plantar  arch.    The  branches 


Chart  No.  24 

Showing  Plantar  Arteries. 

(Superficial  View) 


of  the  Plantar  arch,  besides   distributing  numerous   branches  to  the 
muscles  and  integument  in  the  sole,  are :     (See  Charts  Nos.  23  and  24.) 

1.  The  Posterior  Perforating. 

2.  The  Digital  or  Anterior  Perforating. 

1.     The    Posterior    Perforating    are    three    small   branches    which 
ascend  through  the  back  part  of  the  three  outer  Interosseous  spaces, 


76  THE    HUMAN    FOOT 

and  anastomose  with  the  Interosseous  branches  from  the  Metatarsal 
artery.     (See  Chart  Xo.  23.) 

2.  The  Digital  Branches  are  four  in  number  and  supply  the  three 
outer  toes  and  half  of  the  second  toe.  The  first  passes  along  the 
outer  side  of  the  little  toe.  The  second,  third  and  fourth  run  along 
the  Interosseous  spaces  and  divide  into  two  collateral  branches, 
which  supply  the  adjacent  sides  of  the  three  outer  toes  and  the 
outer  side  of  the  second  toe.  Each  Digital  artery  sends  upward, 
through  the  fore  part  of  the  corresponding  Metatarsal  space,  a  small 
branch  which  communicates  with  the  Interosseous  branches  of  the 
Metatarsal  artery  and  are  called  the  Anterior  Perforating  branches. 
(See  Charts  Nos.  23  and  24.)  This  concludes  the  description  of  the 
arteries  of  the  leg  and  foot,  and  from  the  arrangement  of  these 
arteries  you  can  readily  see  the  perfect  system  of  blood  supply  to 
all  the  tissues  which  are  found  in  these  parts.  Should  any  disturbance 
arise  in  the  blood  vessels  of  the  foot,  it  is  liable  to  cause  a  great  many 
conditions,  such  as  swelling,  enlarged  joints,  etc. 

It  is  very  important  also  to  bear  in  mind  the  location  and  distribu- 
tion of  these  arteries  when  using  mechanical  appliances  in  correcting 
foot  disturbances. 


CHAPTER    X 


THE   VEINS    OF   THE    LEG   AND    FOOT 

In  considering  the  veins  it  is  only  necessary  to  give  here  a  general 
outline  of  their  mode  of  distribution  and  to  describe  a  few  of  the 
chief  veins  of  the  leg  and  foot  in  order  to  understand  their  relation 
to  the  arteries,  etc. 

The  veins  are  vessels  which  serve  to  return  the  blood  from  the 
capillaries  of  the  different  parts  of  the  body  to  the  heart.  They 
consist  of  two  distinct  sets  of  vessels,  the,  Pulmonary  and  Systemic. 
Whereas  we  are  only  to  describe  the  veins  of  the  lower  extremity, 
we  will  only  take  the  Systemic  veins  into  consideration.  The  veins, 
like  the  arteries,  are  found  in  nearly  every  tissue  of  the  body.  They 
commence  by  minute  plexuses  which  receive  the  blood  from  the 
capillaries. 

The  branches  which  have  their  commencement  in  these  plexuses 
unite  together  into  trunks,  and  these  as  they  pass  toward  the  heart 
increase  in  size.  The  veins  are  larger  and  altogether  more  numerous 
than  the  arteries,  hence  the  entire  capacity  of  the  venous  system  is 
much  greater  than  that  of  the  arterial  system.  The  veins  communicate 
very  freely  with  one  another. 

The  Systemic  veins  are  divided  into  the  superficial  and  deep  veins. 
The  superficial  veins  are  placed  beneath  the  integument  between  the 
Superficial  Fascia ;  they  return  the  blood  from  these  structures  and 
communicate  with  the  deep  veins  by  perforating  the  Deep  Fascia. 
The  deep  veins  accompany  the  arteries  and  are  usually  enclosed  in 
the  same  sheath  with  those  vessels,  and  are  called  for  that  reason  the 
Venae  Comites  of  those  vessels. 

Both  sets  of  veins  are  provided  with  valves  which  are  more  numer- 
ous in  the  deep  than  in  the  superficial  set.     The  superficial  veins  of 

77 


78 


THE    HUMAN    FOOT 


SUPERFICIAL 
CIRCUMFLEX- 
ILIAC 


SUPERFICIAL 
-EPIGASTRIC 


SUPERFICIAL 
■  EXTERNAL 
PIED/O 


INTERNAL 

f SAPHENOUS 

VEIN 


Chart  No.  25 

The  Internal  or  Large  Saphenous  Vein  and 

Its  Branches. 


VEINS  OF  THE  LEG  AND  FOOT 


79 


the  lower  extremity  are  two,  the  Internal  or  Long  Saphenous,  and 
the  External  or  Short  Saphenous  veins.  Before  describing  these  two 
veins,  we  must  describe  the  veins  of  the  foot  and  so  upward,  as  the 
blood  returns  from  the  most  distant  point  and  ascends  toward  the 
heart. 


IPOPLITEAL 
VEIN 


a 


EXTERNAL 

-SAPHENOUS 

VEIN 


Chart  No.  26 

External  or  Short  Saphenous 

Vein. 


On  the  Dorsum  of  the  foot  there  is  a  Venous  arch  situated  in  the 
superficial  structures,  over  the  anterior  extremities  of  the  Metatarsal 
bones,  which  terminates  internally  in  the  Long  Saphenous  vein  and 
externally  in  the  Short  Saphenous  vein.     (See  Chart  No.  25.) 

The  Internal  or  Long  Saphenous  Vein  commences  at  the  inner 


80  THE    HUMAN    FOOT 

side  of  the  Venous  arch  on  the  Dorsum  of  the  foot.  It  ascends  in 
front  of  the  inner  Malleolus  and  along  the  inner  side  of  the  leg; 
accompanied  by  the  Internal  Saphenous  nerve,  it  continues  to  ascend 
until  it  terminates  in  the  Femoral  vein.  It  receives,  in  its  course, 
cutaneous  tributaries  from  the  leg.  It  communicates  in  the  foot  with 
the  Internal  Plantar  vein,  in  the  leg  with  the  Posterior  Tibial  veins, 
by  branches  which  perforate  the  Soleus  muscle,  and  also  with  the 
Anterior  Tibial  veins.     (See  Chart  No.  25.) 

The  External  or  Short  Saphenous  Vein  commences  at  the  outer 
side  of  the  Venous  arch  on  the  Dorsum  of  the  foot.  It  ascends  behind 
the  outer  Malleolus  and  along  the  outer  border  of  the  Tendo-Achillis, 
across  which  it  passes  at  an  angle  to  reach  the  middle  line  of  the 
posterior  aspect  of  the  leg.  It  ascends  to  terminate  in  the  Popliteal 
vein,  and  is  accompanied  by  the  External  Saphenous  nerve.  It 
receives  numerous  large  tributaries  from  the  back  part  of  the  leg  and 
communicates  with  the  deep  veins  on  the  Dorsum  of  the  foot.  It  also 
gives  off  a  communicating  branch  which  passes  upward  and  inward 
to  join  the  Internal  Saphenous  vein.  (See  Chart  No.  26.)  The  deep 
veins  are  situated  too  high  up  in  the  leg  to  be  of  any  service  in  the 
consideration  of  the  blood  supply  of  the  foot;  therefore,  this  concludes 
the  description  of  all  of  the  veins  which  will  be  necessary  for  our 
purpose. 


CHAPTER  XI 


THE  NERVES  OF  THE  LEG  AND  FOOT 

Under  this  heading  we  are  to  study  just  those  nerves  which  are 
in  direct  relation  to  the  structures  of  the  lower  limb  alone.  The 
minute  description  of  the  structure  of  a  nerve  was  given  under 
Chapter  V.  For  our  convenience  we  must  commence  with  the  upper- 
most nerve  in  the  leg  supplying  nerve  force  to  the  lower  limb  and 
foot.  The  first  one  to  be  considered  is  the  Great  Sciatic  nerve.  It  is 
not  necessary  to  describe  the  Great  Sciatic  nerve  minutely,  as  it  will 
suffice  to  say  that  this  nerve  gives  off  two  important  branches  which 
supply  the  muscles  of  the  calf  of  the  leg  and  foot,  namely,  the  Internal 
Popliteal  and  External  Popliteal  nerves.     (See  Chart  No.  27.) 

The  Internal  Popliteal  Nerve. — The  larger  of  the  two  terminal 
branches  of  the  Great  Sciatic  nerve  descends  along  the  back  part  of 
the  thigh  to  the  lower  part  of  the  Popliteal  muscle,  where  it  becomes 
the  Posterior  Tibial  nerve  and  lies  in  close  relation  with  the  blood 
vessels.  This  nerve  has  several  branches,  namely,  the  Articular, 
Muscular,  Cutaneous  and  the  External  or  Short  Saphenous  nerve. 

The  Articular  Branches,  usually  three  in  number,  supply  the  knee 
joint. 

The  Muscular  Branches,  four  in  number,  supply  the  Gastrocne- 
mius, Plantaris,  Soleus  and  Popliteus  muscles. 

The  Cutaneous  supplies  the  integument. 

The  External  or  Short  Saphenous  descends  about  the  middle  of 
the  back  of  the  leg  and  receives  a  communicating  branch  from  the 
External  Popliteal  nerve.  It  then  continues  its  course  down  the  leg 
along  the  outer  margin  of  the  Tendo-Achillis,  and  is  distributed  to 
the  integument  of  the  outer  side  of  the  foot  and  little  toe.  (See 
Chart  No.  28.) 

The  Posterior  Tibial  Nerve  commences  at  the  lower  border  of  the 
6  81 


82 


THE    HUMAN    FOOT 


CJuf,. 

Medium 


Quelle 

7lf.<0  O&XURATOn 


SnitsJJ  Sciatic 


Gsca  tSciaticNervl 


Extern  al 
Saphenous 

fostertoir 
Tibial  " 


Plantar 

Cutaneous 


Chart  No.  27 

Nerves  of  Leg  and  Foot. 

(Posterior  View) 


THE    NERVES 


83 


Popliteus  muscle  and  passes  along  the  back  part  of  the  leg  with  the 
Posterior  Tibial  vessels  to  the  interval  between  the  Inner  Malleolus 
and  the  heel,  where  it  divides  into  the  External  and  Internal  Plantar 


Chart  No.  28 
Cutaneous  Nerves  of  the  Lower  Ex- 
tremity.     (Posterior  View) 


nerves.  Besides  these,  it  sends  off  three  smaller  branches,  namely, 
the  Muscular,  Plantar-Cutaneous  and  Articular.  (See  Chart  No.  27.) 
The  Muscular  branches  arise  from  the  upper  part  of  the  nerve  and 
supply  the  Tibialis  Posticus,  Flexor  Longus  Digitorum  and  Flexor 


84 


THE    HUMAN    FOOT 


Longus  Pollicis  muscles.  The  Plantar-Cutaneous  branch  perforates 
the  Internal  Annular  ligament  and  supplies  the  integument  of  the 
heel  and  inner  side  of  the  sole  of  the  foot.  The  Articular  branch  sup- 
plies the  ankle  joint. 


IN7ZRNAL 
PLWTATi 


/zrx 
DIGIT 


£X2FIWAZ 

PZANTAR 


Chart  No.  29 
The  Plantar  Nerves. 


The  Internal  Plantar  Nerve,  the  largest  of  the  two  terminal 
branches  of  the  Posterior  Tibial  nerve,  accompanies  the  Internal 
Plantar  artery  along  the  inner  side  of  the  foot.  It  commences  at  the 
ankle,  passes  forward,  dividing  at  the  bases  of  the  Metatarsal  bones 
into  four  digital  branches,  and  communicates  with  the  External  Plan- 


THE    NERVES  85 

tar  nerve.  (See  Chart  No.  29.)  This  nerve  gives  off  cutaneous 
branches  which  supply  the  integument  of  the  sole  of  the  foot;  muscu- 
lar branches  which  supply  the  Abductor  Pollicis  and  Flexor  Brevis 
Digitorum  muscles ;  articular  branches  to  the  articulations  of  the 
Tarsus  and  Metatarsus,  and  four  digital  branches  which  pass  between 
the  toes  and  are  distributed  as  follows :  The  first  supplies  the  inner 
border  of  the  great  toe;  the  second  bifurcates  to  supply  the  adjacent 
sides  of  the  great  and  second  toes;  the  third  supplies  the  adjacent 
sides  of  the  second  and  third  toes,  and  the  fourth  supplies  the  cor- 
responding sides  of  the  third  and  fourth  toes. 

The  External  Plantar  Nerve,  the  smaller  of  the  two  terminal 
branches  of  the  Posterior  Tibial  nerve,  completes  the  nervous  supply 
to  the  structures  of  the  foot,  being  distributed  to  the  little  toe  and  one- 
half  of  the  fourth  toe,  as  well  as  to  most  of  the  deep  muscles.  It 
passes  obliquely  outward  to  the  outer  side  of  the  foot,  lying  between 
the  Flexor  Brevis  Digitorum  and  Flexor  Accessorius,  and  divides  into 
a  superficial  and  deep  branch  supplying  the  Flexor  Accessorius  and 
Abductor  Minimi  Digiti  muscles. 

The  Superficial  Branch  separates  into  two  Digital  nerves.  One  sup- 
plies the  outer  side  of  the  little  toe,  the  Flexor  Brevis  Minimi  Digiti, 
and  the  two  Interosseous  muscles  of  the  fourth  Metatarsal  space,  the 
other  digital  branch  supplying  the  adjoining  sides  of  the  fourth  and 
fifth  toes,  and  communicates  with  the  Plantar  nerve. 

The  Deep  or  Muscular  Branch  accompanies  the  External  Plantar 
artery  into  the  deep  part  of  the  sole  of  the  foot  and  supplies  all  the 
Interosseous  muscles  (except  those  in  the  fourth  Metatarsal  space), 
the  two  outer  Lumbricales,  the  Adductor  Pollicis  and  the  Transversus 
Pedis.     (See  Chart  No.  29.) 

The  External  Popliteal  or  Peroneal  Nerve  is  situated  about  the 
Popliteal  space  in  the  back  of  the  leg,  descends  to  the  Peroneus 
Longus  muscle,  where  it  divides  into  the  Anterior  Tibial  and  Musculo- 
cutaneous nerves.  (See  Chart  No.  27.)  The  branches  of  the  Ex- 
ternal Popliteal  nerve  before  its  division  are  the  Articular  and  Cuta- 
neous branches,  which  supply  the  knee  joint  and  the  integument  in 
that  region. 


86 


THE    HUMAN    FOOT 


The  Anterior  Tibial  Nerve  commences  at  the  bifurcation  of  the 
Peroneal  nerve,  passes  forward  and  then  descends  to  the  front  of  the 
ankle  joint,  where   it  divides   into  an   external   and  internal  branch. 


Sartorius 


interior 
dural 


Middle. 
Cutaneous 


Mvsculo- 
Cutaneous 


interior 
Tibial 


Chart  No.  30 
Nerves  of  the  Leg  and  Foot. 


(See  Chart  No.  30.)  The  branches  of  the  Anterior  Tibial,  in  its 
course  through  the  leg,  are  the  muscular  nerves  to  the  Tibialis  Anticus, 
Extensor  Longus  Digitorum,  Peroneus  Tertius  and  Extensor  Proprius 
Pollicis  muscles,  and  an  articular  branch  to  the  ankle  joint. 


THE    NERVES  87 

The  External  or  Tarsal  Branch  passes  outward  across  the  Tarsus 
and  supplies  the  Extensor  Brevis  Digitorum  and  the  articulations  of 
the  Tarsus  and  Metatarsus. 

The  Internal  Branch  is  a  continuation  of  the  Anterior  Tibial  nerve. 
It  accompanies  the  Dorsalis  Pedis  artery  along-  the  inner  side  of  the 
Dorsum  of  the  foot  and,  at  the  first  Interosseous  space,  divides  into 
two  branches,  which  supply  the  adjacent  sides  of  the  great  and  second 
toes,  communicating  with  the  internal  division  of  the  Musculo-Cu- 
taneous  nerve. 

The  Musculo-Cutaneous  Nerve  supplies  the  muscles  on  the  Fibular 
side  of  the  leg  and  the  integument  of  the  Dorsum  of  the  foot.  It  passes 
forward  and  at  the  lower  third  of  the  leg  it  divides  into  two  branches. 
In  its  course  it  gives  off  muscular  branches  to  the  Peroneus  Longus 
and  Brevis  and  Cutaneous  filaments  to  the  integument  of  the  lower 
part  of  the  leg.     (See  Chart  No.  30.) 

The  Internal  Branch  passes  in  front  of  the  ankle  joint  along  the 
Dorsum  of  the  foot,  supplying  the  inner  side  of  the  great  toe  and  the 
adjoining  sides  of  the  second  and  third  toes,  also  supplying  the  integu- 
ment of  the  inner  ankle,  and  inner  side  of  the  foot,  communicating  with 
the  Internal  Saphenous  nerve,  and  joins  with  the  Anterior  Tibial  nerve 
between  the  great  and  second  toe. 

The  External  Branch  passes  along  the  outer  side  of  the  Dorsum  of 
the  foot,  to  be  distributed  to  the  adjoining  sides  of  the  third,  fourth 
and  fifth  toes,  also  supplying  the  integument  of  the  outer  ankle  and 
outer  side  of  the  foot,  communicating  with  the  Short  Saphenous  nerve. 

From  the  foregoing  description  of  the  nerves,  it  will  be  seen  that 
every  structure  of  the  leg  and  foot  is  supplied  with  a  number  of 
nerves  which  are  intimately  related  to  these  structures,  and  any 
malformation  of  the  foot  may  cause  pressure  on  these  nerves,  resulting 
in  severe  pain.  Thus  it  is  important  that  you  have  a  knowledge  of  the 
nerves  described  in  this  chapter. 


CHAPTER    XII 


THE  SKIN  AND  NAILS 

Under  this  chapter  we  will  consider  the  outermost  structures  of 
the  foot,  namely,  the  Skin  and  Xails,  and  also  give  a  resume  of  the 
entire  anatomy  of  the  leg  and  foot  in  general. 

THE  SKIN 

The  skin  may  be  regarded  as  a  covering  for  the  protection  of  the 
deeper  tissues ;  it  is  also  an  important  excretory  and  absorbing  organ. 
It  is  the  principal  seat  of  the  sense  of  touch  and  the  chief  factor  in 
the  regulation  of  the  body  temperature.  It  consists  principally  of  a 
layer  of  vascular  tissue  "named  the  Derma,  or  Corium  (true  skin), 
and  an  external  covering  of  epithelial  cells,  termed  the  Epidermis  or 
Cuticle.  On  the  inner  layer  are  found  the  Sweat  Glands,  Hair  Follicles 
and  Sebaceous  Glands.     (See  Chart  Xo.  31.) 

The  Epidermis,  or  Cuticle,  is  an  Epithelial  structure  forming  the 
defensive  covering  to  the  true  skin,  and  varies  in  thickness  in  different 
parts.  In  the  soles  of  the  feet  it  is  thick,  hard  and  horny  in  texture, 
as  these  parts  are  exposed  to  intermittent  pressure,  while  on  the 
Dorsum  of  the  foot  this  layer  is  much  thinner  and  exceedingly  fine  in. 
texture.  The  deep  surface  of  the  Epidermis  is  accurate^  molded 
upon  the  Derma. 

The  superficial  layer  of  cells  of  the  Epidermis,  called  the  horny 
layer  (Stratum  Corneum),  is  the  layer  most  frequently  involved  in 
corns  and  callouses  when  subjected  to  pressure  and  friction. 

The  Derma  is  a  tough,  flexible  and  highly  elastic  structure  for  the 
purpose  of  protecting  the  parts  beneath  from  violence,  and  consists 
of  fibrous  connective  tissues  with  a  large  admixture  of  elastic  fibers, 
blood  vessels  and  nerves. 

88 


THE    SKIN    AND    NAILS 


89 


APPENDAGES  OF  THE  SKIN 

The  Hair. — Hair  is  found  on  every  part  of  the  surface  of  the  body 
except  the  palms  of  the  hands  and  the  soles  of  the  feet.  A  hair  con- 
sists of  a  root,  the  part  implanted  in  the  skin;  the  shaft  or  stem, 
the  portion  projecting  from  the  surface  of  the  skin. 

The  root  at  its  extremity  is  bulbous  and  is  lodged  in  an  involution 
of  epidermis  called  the  hair  follicle. 


Superficial  Layers.  §B 

Rete    Mucosum. 
Papilla   Corium. 

Fat  Cells.  ,< 

Fibrous   Tissue. 

Sebaceous   Glands.'1 

Hair  Follicle 


g  I  Epidermis  or 
S  |  Cuticle. 


erma  or  Cutis. 


Nutrient  Artery, 


Chart  No.  31 
Sectional   View  of  the   Skin   (Magnified). 


Sebaceous  Glands  are  small  sacculated  glandular  organs  lodged  in 
the  substance  of  the  Corium.  They  are  found  in  most  parts  of  the 
skin,  but  are  wanting  in  the  palms  of  the  hands  and  the  soles  of  the 
feet.  The  orifices  of  the  ducts  open  most  frequently  into  the  hair 
follicles. 

The  Sweat  Glands  or  Sudoriferous  Glands  are  the  organs  by  which 
a  large  portion  of  the  aqueous  and  gaseous  materials  is  excreted  by 
the  skin.     They  are  situated  in  the  Corium  and  subcutaneous  areolar 


90  THE    HUMAN    FOOT 

tissue  surrounded  by  adipose  tissue.  They  are  small,  lobular,  reddish 
bodies  consisting  of  a  single  convoluted  tube  from  which  the  efferent 
duct  proceeds  upward  through  the  Corium  and  Cuticle,  becomes 
dilated  and  opens  on  the  surface  of  the  Cuticle  by  an  oblique  valve- 
like aperture  called  a  pore. 

The  size  of  the  glands  varies  and  they  are  most  numerous  in  the 
palms  of  the  hands  and  the  soles  of  the  feet. 

THE    NAILS 

The  nails  are  flattened,  horny  structures  placed  upon  the  terminal 
phalanges  of  the  toes.  Each  nail  is  implanted  by  a  portion,  called 
the  Root,  into  a  groove  in  the  skin,  the  exposed  portion  being  called 
the  Body,  and  the  anterior  extremity  the  Free  Edge.  The  nail  has  a 
firm  adhesion  to  the  cutis,  being  accurately  molded  upon  its  surface. 
The  part  of  the  cutis  beneath  the  body  and  root  of  the  nail  is  called 
the  Matrix,  because  it  is  the  part  from  which  the  nail  is  produced. 
The  nails  protect  the  terminal  ends  of  the  toes,  and  are  subject  to 
many  malformations  due  to  the  pressure  they  receive  from  shoes,  etc. 

GENERAL    REVIEW 

This  concludes  the  description  of  all  the  soft  parts  of  the  leg  and 
foot.  I  will  now  give  you  a  basis  upon  which  you  may  distinguish 
and  clearly  understand  how  the  various  malformations  occur. 

Let  us  now  look  over  the  foregoing  pages  and  review  in  general 
the  anatomy  of  the  leg  and  foot.  First  the  bones  of  the  leg  and  foot 
were  described  as  they  make  up  the  framework  of  these  parts,  then 
the  ligaments  were  considered,  being  the  structures  which  keep  the 
bones  in  their  position ;  after  that  the  muscles  and  tendons  were  fully 
described,  as  they  are  the  structures  which  produce  movement  of 
the  different  bones.  Then  the  blood  vessels,  such  as  arteries  and 
veins,  were  described,  as  it  is  their  function  to  supply  these  struc- 
tures with  nourishment  and,  ultimately,  the  nerves  and  the  outer 
covering  of  these  parts;  thus  giving  you  a  detailed  description  of 
the  lea:  and  foot. 


CHAPTER    XIII 


COMPARATIVE  ANATOMY 

The  purpose  of  this  chapter  is  to  compare  the  foot  with  the  hand, 
the  foot  being  the  distal  member  of  the  lower  extremity,  while  the 
hand  is  the  distal  member  of  the  upper.  By  such  a  comparison  we 
obtain  the  most  valuable  aid  in  the  comprehension  of  its  structure. 
It  has  been  stated  on  several  occasions  that  the  foot  is  merely  a 
hand  altered  by  the  functions  of  support  and  locomotion  which  it 
is  obliged  to  perform. 

While  it  is  generally  true  that  the  feet  and  hands  are  constructed 
Upon  similar  plans,  it  must  be  remembered  that  the  differentiation 
evolves  from  the  animal  series. 

The  similarity  of  the  anterior  and  posterior  extremities  of  a 
quadruped,  such  as  the  horse,  for  instance,  disappears  to  a  consid- 
erable extent  when  the  anatomical  structure  is  minutely  examined. 
Also,  in  quadrupedal  locomotion  the  posterior  extremities  are  the 
ones  most  active  in  propelling  the  body,  the  anterior  limbs  being 
chiefly  for  support  and  equipoise. 

The  impression  of  the  fore  feet  of  an  unshod  horse  is  different 
from  that  of  the  hind  feet,  due  to  the  fact  that,  as  the  fore  limbs  come 
to  be  more  used  for  the  purpose  of  prehension  and  dexterity,  the  dif- 
ference in  structure  is  more  pronounced. 

The  higher  apes  were  improperly  called  quadrumana;  for  no 
animal,  zoologically  speaking,  has  four  feet  anatomically  similar;  nor 
has  any  animal  four  organs  that  can  be  called  hands.  The  differ- 
ences are  various  according  to  the  adaptation  of  the  anterior  and 
posterior  members  for  the  special  activities  of  the  animal. 

The  bones  of  the  Carpus  are  never  found  to  be  the  same  as  those 
of  the  Tarsus,  varying  either  in  number  or  in  the  union  of  the 
various    osseous    elements.      There    is    not,    properly    speaking,    any 

91 


92 


THE    HUMAN    FOOT 


Chimpanzee's  Hand. 


Chimpanzee's  Foot. 


Human   Hand. 

Chart  No.   33 
Comparing  the  Human  Hand  and  Foot  with  the  Ch 


Human  Foot. 


impanzee's. 


COMPARATIVE    ANATOMY  93 

opposability  of  the  great  toe  in  apes,  as  it  cannot  be  carried  around 
and  placed  at  will  against  the  various  other  toes;,  but  is  set  at  a 
wider  angle  than  the  others  in  order  that  it  may  be  used  like  the 
curve  of  a  pincers,  or  of  a  cramp-iron,  for  grasping  and  climbing. 
The  posterior  extremities  of  apes  are  merely  feet  adapted  for  walk- 
ing upon  trees,  the  resemblance  of  the  foot  or  "hind-hand"  to  a  true 
hand  being  only  skin  deep. 

There  appears  from  the  structure  of  the  human  foot  no  reason 
to  doubt  that  it  has  been  developed  from  an  organ  adapted  for  the 
same  use.  Strong  evidence  of  this  is  found  in  the  fetal  condition 
of  the  foot,  which  approaches  in  many  respects  that  of  the  Anthro- 
poid apes,  there  being  less  development  of  the  heel,  an  arrange- 
ment of  the  joints  which  permits  more  inversion  of  the  sole,  and 
a  difference  in  the  .corresponding  length  of  the  first  and  second 
Metatarsal  bones,  indicating  that  the  adult  condition  in  which  the 
great  toe  is  as  long  or  longer  than  the  others  has  been  gradually 
acquired. 

Chart  No.  33  shows  the  hand  and  foot  of  the  chimpanzee  con- 
trasted with  the  same  members  in  the  adult  man.  In  the  gorilla 
the  resemblance  to  the  human  hand  and  foot  is  still  greater. 

The  feet  of  a  child  that  has  never  walked  show  decided  dif- 
ferences in  power  of  using  the  toes,  there  being  considerable  grasp 
and  the  same  imperfect  opposability  of  the  great  toe  as  is  seen  in 
the  apes. 

The  markings  on  the  foot  of  a  child  that  has  never  worn  a  shoe, 
nor  stood  alone  upon  its  feet,  resemble  somewhat  those  of  the 
palm  of  the  hand,  indicating  considerable  freedom  of  flexion  and  a 
certain  amount  of  independent  use  of  the  great  toe. 

They  almost  entirely  disappear  after  the  foot  is  used  as  a  sup- 
port. The  power  of  the  great  toe  may,  however,  be  kept  up  if  the 
feet  are  not  confined,  and  many  savage  tribes  use  the  feet  for 
grasping. 

Among  Australian  savages  this  grasping  power  is  of  great  as- 
sistance in  climbing  trees,  and  they  habitually  pick  up  a  spear  or 
similar  object  with  the  foot.     Nubian  horsemen  are  said  to  use  the 


94  THE    HUMAN    FOOT 

reins,  and  Chinese  boatmen  to  pull  an  oar,  by  means  of  the  great 
toe.  Occasionally  persons  may  be  found  who  are  either  born  with- 
out hands,  or  losing  them  early  in  life,  have  acquired  the  habit  of 
using  the  foot  for  various  acts  ordinarily  performed  by  the  hands, 
and  can  thread  a  needle  fas  the  Hindoo  tailors),  use  scissors,  or 
even  write  with  the  toes.  The  fact  that  walking'  in  the  erect  position 
is  learned  only  with  difficulty  shows  that  it  is  a  late  acquirement. 

The  main  characteristics  of  the  human  foot  are.  therefore,  those 
which  adapt  it  for  support  and  locomotion.  For  this  purpose  a  most 
beautiful  structural  arrangement  has  been  effected,  combining  great 
strength  with  peculiar  elasticity  and  lightness.  The  bones  are  set  in 
the  form  of  a  vault,  supported  at  the  points  connected  by  arches,  two 
of  these  starting  from  the  same  point  of  the  heel  (the  Tuberosity  of 
the  Os  Calcis)  and  extending  forward,  one  to  the  ball  of  the  great  toe 
(head  of  first  Metatarsal),  the  other  to  a  corresponding  point  on  the 
little  toe.  These  arches  are  known  as  the  Inner  and  Outer  Longitu- 
dinal. The  third  arch  is  transverse,  connecting  the  anterior  ends  of 
the  longitudinal  ones.     (See  Charts  of  Arches  in  Chapter  IV.) 

The  Inner  Longitudinal  arch  is  formed  by  the  Os  Calcis  behind 
the  first,  second  and  third  Metatarsal  bones,  the  Cuneiform  and 
Scaphoid  bones  in  front,  with  the  Astragalus  set  at  the  vertex  as  a 
keystone. 

The  Outer  Longitudinal  arch,  which  is  nearly  flat,  is  formed  by 
the  Os  Calcis,  Cuboid,  and  two  outer  Metatarsal  bones,  which  articu- 
late with  it. 

The  transverse  arch  is  formed  behind  by  the  three  Cuneiform 
bones  and  the  Cuboid,  in  front  by  the  Metatarsal  bones.  It  should 
be  noted  that  the  curvature  of  the  arch  diminishes  as  the  toes  are 
approached  until  it  reaches  the  heads  of  the  Metatarsal  bones,  the 
weight  being  fully  upon  them  all.  The  imprint  of  a  normal  human 
foot  shows  this  clearly. 

The  height  of  the  arches  forms  the  instep,  a  feature  peculiar  to 
man,  and  which  varies  considerably  in  different  races,  being  generally 
higher  in  the  Indo-European  than  in  others.  Arabs  are  said  to  boast 
that  their  insteps  are  so  high  that  water  will  run  under  them  without 


COMPARATIVE    ANATOMY  95 

wetting  the  sole.  The  Andalusian  instep  is  said  to  be  famous.  A 
popular  saying  has  it  that  the  foot  of  the  negro  is  so  flat  that  it  makes 
a  hole  in  the  ground.  A  very  amusing  proof  of  this  primitive  condi- 
tion of  the  negro  foot  may  be  noticed  in  Southern  cities  where,  during 
the  heat  of  summer,  it  is  customary  to  wet  the  pavements  in  the  even- 
ing. It  is  not  unusual  to  see  barefooted  negro  boys  whose  feet  are 
so  flat  that  atmospheric  pressure  makes  them  adhere  slightly  when 
applied  to  the  wet  and  smooth  pavement,  in  the  same  way  that  a 
boy's  leather  sucker  adheres  to  a  smooth  stone,  and  it  is  a  favorite 
pastime  with  such  gifted  individuals  to  walk  the  streets  producing  a 
somewhat  startling  report  every  time  the  foot  is  withdrawn  from  the 
pavement. 

It  is,  perhaps,  not  without  some  reason  that  the  height  of  the 
instep  is  considered  a  mark  of  aristocracy,  as  it  appears  to  be  one  of 
the  signs  of  complete  adaptation  to  the  erect  posture  and  to  locomo- 
tion in  that  position. 

Man  is  the  only  animal  that  has  the  feet  placed  at  right  angles  to 
the  axis  of  the  body,  most  mammalia  not  touching  the  ground  with 
the  Os  Calcis  at  all. 

The  horse,  for  instance,  literally  walks  upon  the  points  of  the  toes, 
the  hoof  being  comparable  with  the  nails  of  the  human  foot,  and  the 
hock  or  "knee"  being  the  tuberosity  of  the  Os  Calcis.  There  appears 
to  be  some  relation  between  this  ascension  of  the  Os  Calcis  and  the 
fleetness  of  the  animal,  as  those  who  are  the  most  rapid  have  the 
bones  so  arranged  that  they  walk  merely  upon  the  tips. 

If  support  alone  were  needed  there  would  be  no  necessity  for  the 
Metatarsal  bones  and  toes,  as  may  be  seen  in  those  who  have  had 
them  amputated.  The  anterior  part  of  the  arch  is  therefore  for  pur- 
poses of  locomotion,  and  it  may  be  noted  that  in  running  the  heel  is 
raised  off  the  ground  and  the  anterior  part  only  is  used,  the  ana- 
tomical relation  of  the  bones  to  the  ground  being  similar  to  that  which 
occurs  ordinarily  in  the  foot  of  the  hoofed  animals.  The  great  swift- 
ness and  lightness  of  motion  of  a  dancer  is  owing  to  her  ability  to 
dispense  entirely  with  the  posterior  portion  of  the  arch. 

Owing  to  this  difference  of  formation  the  anterior  and  posterior 


96  THE    HUMAN    FOOT 

pillars  of  the  longitudinal  arches  differ — the  posterior,  being-  for  sup- 
port, is  short,  thick  and  strong,  being  of  but  one  bone ;  the  anterior, 
composed  of  several  bones,  is  longer,  so  that  the  motion  of  raising 
the  heel  can  be  quickly  performed.  The  apparent  length  of  the  heel 
in  the  African  race  is  caused  by  the  flattening  of  the  arch  rather  than 
by  a  real  projection. 

Long  heels  are  characteristic  among  any  sufferers  of  flat-foot  or 
broken  down  arch  when  the  posterior  portion  is  mostly  involved,  the 
Os  Calcis  is  forced  downward  and  backward  and  unless  the  weakened 
condition  is  corrected. 

The  number  of  bones  in  the  anterior  arch  greatly  aids  in  the  dis- 
tribution of  the  force,  as  one  may  see  who  will  take  the  trouble  to 
note  the  difference  "in  shock"  which  occurs  when  alighting  upon  the 
heels  rather  than  upon  the  balls  of  the  toes.  We  will  now  proceed  to 
consider  the  complete  structure  of  the  foot  as  a  whole,  including  its 
physiology  and  mechanical  principles. 


CHAPTER    XIV 


PHYSIOLOGY 

The  human  body  is  composed  of  different  parts  which  are  called 
organs.  Although  each  organ  has  its  own  special  work  to  perform,  it 
also  acts  in  harmony  with  the  other  organs.  Thus  this  relationship 
which  exists  between  the  organs  enables  us  to  group  them  into  sepa- 
rate bodies,  which  are  termed  "systems,"  namely,  the  Circulatory 
system,  including  the  heart,  arteries,  veins,  etc.,  conveying  the  blood 
to  different  parts  of  the  body;  Respiratory  system,  including  air 
passages,  lungs,  etc.,  which  are  concerned  in  the  act  of  breathing; 
the  Digestive  system,  which  deals  with  the  digestion  of  food;  the 
Excretory  system,  which  rids  the  body  of  its  waste  products;  the 
Muscular  system,  with  movement,  and  the  Skeletal  system,  with  the 
support  of  the  softer  parts ;  the  Nervous  system,  including  the  brain, 
spinal  cord  and  nerves,  is  the  greater  master  system  of  the  body, 
which  controls  and  regulates  the  functions  of  the  other  systems. 

THE  FUNCTIONS  OF  THE  FOOT 

In  its  natural  state,  the  human  foot  presents  an  example  of  the 
most  perfect  mechanism  connected  with  the  human  frame.  The  frame- 
work of  the  foot  is  composed  of  twenty-six  bones:  the  seven  bones 
in  the  Tarsus,  and  the  five  in  the  Metatarsus,  which  unite  to  form 
the  arch  and  give  elasticity  by  yielding  to  pressure,  and  the  four- 
teen bones  which  form  the  toes  or  phalanges. 

All  of  the  fundamental  tissues  of  the  body  enter  into  its  complex 
parts,  such  as  the  ligaments,  composed  of  fibrous  inelastic  bands  which 
unite  the  bones  at  the  points  of  articulation;  the  strata  of  muscles 
arranged  next  to  the  bones  which,  by  their  contraction  and  relaxation, 
produce  motion  and  locomotion,  enabling  the  foot  to  bear  the  weight 
of   the   body;   the    nerves,    extending   in   various   branches    from   the 

t  97 


98  THE    HUMAN    FOOT 

brain  and  spinal  cord,  through  which  messages  are  conveyed  to  the 
mind,  knowledge  of  substances  with  which  the  foot  comes  in  con- 
tact, and  through  which  the  power  of  the  will  is  exercised  upon  the 
muscles,  causing  them  to  contract;  the  blood  vessels  which  convey 
the  blood  to  the  different  parts,  nourishing  and  promoting  their 
growth;  the  synovial  membranes  and  bursae  sac  or  capsules,  which 
secrete  a  viscid  liquid,  lubricating  the  joints,  preserving  their  normal 
state;  the  cellular  and  fatty  tissues,  which  serve  to  cushion,  giving 
the  foot  the  perfect  symmetry  and  artistic  beauty  with  which  all  are 
familiar,  and  the  skin  and  its  appendages,  which  conform  to,  cover 
and  protect  the  delicate  structures  beneath,  and  which  contain  nerves, 
veins,  arteries,  secretory  and  excretory  glands,  in  direct  relationship 
with  all  parts  of  the  body  system. 

When  you  realize  the  complexity  of  the  structures,  the  complete- 
ness of  every  form  of  tissue  involved  in  the  physiological  construction 
of  the  human  foot,  it  is  then  clear  what  an  important  part  of  the 
body  this  is. 

MOVEMENTS 

The  various  kinds  of  movements  which  the  foot  is  capable  of  per- 
forming are  known  as  Flexion  and  Extension,  Abduction  and  Adduc- 
tion, Inversion  and  Eversion : 

Abduction  of  the  Foot. — Is  the  act  of  drawing  the  foot  away  from 
the  center  or  median  line,  when  acted  upon  by  the  abductor  muscles. 
(Fig.  2,  Chart  No.  35.) 

Adduction  of  the  Foot. — Is  the  drawing  of  the  foot  towards  the 
center  or  median  line  of  the  body,  when  acted  upon  by  the  adductor 
muscles.     (Fig.  1,  Chart  No.  35.) 

Flexion  of  the  Foot. — Is  the  act  of  bending  the  joints  when  acted 
upon  by  the  Flexor  muscles. 

Extension  of  the  Foot. — Is  the  stretching  of  the  foot  when  acted 
upon  by  the  Extensor  muscles. 

Inversion  of  the  Foot. — Is  the  inward  turning  of  the  foot. 

Eversion  of  the  Foot. — Is  the  outward  turning  of  the  foot. 

The  movements  of  Flexion  and  Extension  are  most  marked  at  the 


PHYSIOLOGY 


99 


ankle  joint,  and  are  known  as  Plantar  and  Dorsal  Flexion,  respec- 
tively. With  the  foot  upon  the  ground  the  leg-  can  be  flexed  on  the 
foot  until  it  forms  an  angle  of  approximately  seventy  to  seventy-five 
degrees  with  the  sole  of  the  foot.  When  Dorsal  Flexion  is  limited, 
as  when  the  Tibia  can  be  flexed  only  to  a  right  angle,  an  abnormal 
condition  exists,  and  the  proper  functioning  of  the  foot  is  interrupted. 


\\ 


'A  „  >A- 


.Voluntary  Adduction. 


Chart  No.  34 


Plantar  Flexion  of  the  foot  is  greater,  extending  to  form  an  angle  of 
about  one  hundred  and  fifty  degrees  with  the  leg,  because  of  the  con- 
vexity of  the  outer  border  of  the  pulley-like  process,  or  Trochlear  of 
the  Astragalus.  The  interior  portion  of  that  bone  is  turned  slightly 
inward  when  in  full  Plantar  Flexion,  and  less  markedly  outward  when 
in  full  Dorsal  Flexion.     This  is  clearly  demonstrated  by  the  outward 


100 


THE    HUMAN    FOOT 


thrust  of  the  ankle  when  a  person  rises  on  tip-toes,  the  weight  of 
the  body  preventing  the  toes  being  carried  inward  and,  therefore, 
as  Plantar  Flexion  progresses  the  ankle  is  forced  outward.  It  can 
thus  be  seen  by  the  above  illustration  that  Plantar  Flexion  with  Ad- 
duction and  Dorsal  Flexion  with  slight  Abduction  is  normal  at  the 


Fig.   1.     Involuntary   Adduction. 


Chart  Xo.  35 

Fig.  2.     Involuntary  Abduction. 


ankle  joint.  Inversion  and  Eversion,  in  which  the  sole  is  drawn  in- 
ward or  towards  the  center  and  outward  or  away  from  the  center,  are 
the  chief  movements  at  the  Sub-Astragaloid  joint.  With  Eversion  and 
Inversion  there  is  also  some  Adduction  and  Abduction  and  rotation 
about  a  vertical  axis. 


PHYSIOLOGY  101 

The  Astragalo-Scaphoid  and  the  Calcaneo-Cuboid  joints  are  usually 
spoken  of  as  one,  and  called  the  Medio-Tarsal  joint.  The  movement  at 
this  joint  is  about  a  vertical  axis  in  the  direction  of  Abduction  and 
Adduction ;  also  rotation  on  an  Anterio-Posterior  axis,  and  movement 
on  a  Transverse  axis,  producing  flexion  and  extension. 

The  Arthrodial  joints,  which  are  anterior  to  the  Medio-Tarsal  joint, 
have  only  slight  movements,  but  are  necessary  in  the  normal  use  of 
the  foot.  Any  abnormality  of  the  Metatarso-Phalangeal  joints,  espe- 
cially the  first,  may  occasion  serious  loss  of  function  of  those  joints. 

From  the  above  the  student  will  see  that  there  are  three  principal 
axes  of  movement  in  the  foot,  namely,  (a)  Transverse,  through  the 
lower  part  of  the  Astragalus,  in  which  the  movements  are  chiefly 
extension  and  flexion;    (b)   Horizontal,  extending  anterio-posteriorly 


Chart  No.  36 
Manner  of  Walking — How  Steps  Are  Made. 

through  the.  Sub-Astragaloid  joint,  where  inversion  and  eversion  are 
the  most  marked  movements ;  (c)  Vertical,  through  the  Medio-Tarsal 
joint,  abduction  and  adduction  of  the  fore  foot  being  the  movements 
most  marked  at  this  point. 

The  advantage  of  the  construction  of  the  great  toe  is  readily  seen 
when  it  is  learned  that  by  its  large  size  it  forms  a  firm  and  solid  base; 
and  by  its  division  into  two  phalanges,  with  two  flexor  muscles  one 
to  each,  is  effective  in  holding  them  down  and  keeping  it  straight  in 
all  its  length.  Motion  in  the  first  Metatarso-Phalangeal  joint  is  chiefly 
in  a  plane  downward  and  inward,  away  from  the  other  toes  and 
towards  the  middle  line  of  the  body.  When  at  rest  the  great  toe  is 
drawn  towards  the  other  toes  and  slightly  dorsal  flexed ;  in  action  it 
is  never  flexed  or  extended,  is  in  a  line  with  the  foot,  and  abducted. 
Thus  the  space  noticed  between  the  great  and  second  toes. 


CHAPTER    XV 


MECHANICAL  CONSIDERATION  OF  THE 
HUMAN   FOOT 

Under  this  heading  we  must  have  a  general  review  of  the  complete 
foot  from  the  external  surface.  We  have  a  member  whose  function 
is  to  supply  means  of  locomotion  to  the  body — a  framework  of  bone 


Chart  No.  37 
Manner  of  Balance  in  Walking. 

supported  by  ligaments  and  muscles,  and  moved  by  muscles  and  their 
attachments  through  nerve  impulses.  With  this  combination  the  legs 
and  feet  in  walking  form  a  combined  system  of  levers  that  work 
together.  The  ground  under  the  feet  is  a  fulcrum  to  this  system.  It 
carries  the  weight  of  the  body  and  any  burden  in  addition  to  it,  and 

102 


MECHANICAL    CONSIDERATION 


103 


when  we  examine  the  foot  in  detail  we  find  almost  every  bone  forms 
a  lever,  and  every  articulation  a  fulcrum,  to  the  contracting-  muscles 
and  force. 

It  is  now  established  that  the  body's  weight  and  its  burden  is 
carried  into  the  foot,  that  it  has  a  power  of  movements  that  propel 
the  body,  and  it  is  now  necessary  to  review  the  inner  Longitudinal 
arch,  the  shorter  or  outer  Longitudinal  and  Anterior  Transverse  arch. 
(Charts  Nos.  36  and  37.) 


Chart  No.  38 

Weight  Is  Carried  at  the  Three 

Points. 


Then  the  weight  carrying  points  on  the  foot  are  the  heel  and  the 
heads  of  the  first  and  fifth  of  the  Metatarsals.  The  movements  in 
walking  then  may  be  described  as  follows :     (See  Chart  No.  38.) 

Starting  from  a  standing  position,  the  body  in  erect  attitude,  and 
leading  with  the  right  foot,  the  first  thing  done  is  gently  to  throw 
the  whole  weight  of  the  body  upon  the  rear  or  left  foot,  and  as  soon 
as  the  right  foot  is  relieved  it  leads  off,  the  right  leg  being  stretched 
forward  while  the  foot  is  being  at  the  same  time  extended  by  the 


104  THE    HUMAN    FOOT 

contraction  of  the  muscles  of  the  calf  of  the  leg  and  sole  of  the  foot, 
so  that  the  sole  as  it  advances  remains  nearly  parallel  to  the  ground. 

The  right  leg  and  foot  being  thus  extended,  the  center  of  gravity- 
is,  by  the  force  of  other  muscles  of  the  body,  also  gradually  thrown 
forward,  while  the  heel  of  the  left  foot  by  itself,  and  the  contrac- 
tion of  the  muscles  of  the  calf  of  the  leg  and  sole  of  the  foot,  is 
raised  from  the  ground,  and  the  whole  weight  of  the  body  for  a 
moment  of  time  is  being  placed  upon  the  base  of  the  left  foot ;  then 
from  this  point  the  weight  is  thrown  forward  upon  the  right  foot, 
and  in  this  manner  uniform  progression  is  produced. 

The  action  of  the  center  of  gravity  thus  gradually  brought  forward 
from  the  right  foot,  the  left  foot  at  the  same  time  being  raised  from  the 
ground,  is  then  moved  past  the  right  leg  when  it  is  next  extended,  so 
that  step  by  step  the  force  and  center  of  gravity  moving  from  foot  to 
foot  gives  the  movements  of  the  foot  in  walking.  As  will  be  seen  in  the 
illustration,  the  heel  strikes  the  ground  first,  with  the  toes  slightly 
pointed  upward;  the  ankle  joint  is  held  firmly  by  the  muscular 
groups,  the  latter  yielding  as  the  center  of  gravity  is  advanced,  and 
as  more  an  '  more  weight  is  thrown  on  one  foot  by  propulsion  from 
the  other.  In  the  method  of  walking  and  stepping  lively  there  is 
a  tendency  to  involuntary  adduction  to  the  fore  part  of  the  foot,  but 
where  a  person  walks  slowly,  lingering  along,  in  order  to  maintain 
the  equilibrium,  the  foot  assumes  an  abducted  position,  and  this 
position  is  a  forerunner  to  weakened  arch  and  later  flat  foot,  due 
to  the  inward  and  downward  rotation.  ( See  Chart  Xo.  39.)  Therefore, 
it  can  be  seen  that  from  a  standpoint  of  flat  foot  it  is  less  liable  to  occur 
in  the  fast  walkers  than  those  persons  whose  occupation  or  habits 
cause  them  to  walk  slowly  and  with  the  feet  in  an  abducted  position. 
The  flexible,  graceful  movements  of  the  feet  in  walking  are  due  to 
the  many  anatomical  points  which  we  have  considered  in  their 
structure.  The  Longitudinal  and  Transverse  arches  permit  of  con- 
siderable grace  and  elasticity  to  the  steps,  also  give  a  fulcrum, 
strength  and  stability  without  diminishing  the  graceful,  elastic  move- 
ments. It  is  also  through  these  many  articular  points  that  fracture 
of  the  foot  is  less  liable. 


MECHANICAL    CONSIDERATION 


105 


There  has  been  much  discussion  as  to  the  correct  manner  of  walk- 
ing, whether  the  heel  or  toe  walking  is  more  correct,  but  it  would 
appear  from  the  careful  study  of  the  feet  that  as  long  as  the  heel 
reaches  the  ground  at  every  step,  the  strong  tendons  and  a  soft  pad 
covered  with  thick  skin,  makes  it  better  adapted  than  any  other 
part  of  the  foot  for  contact  with  the  ground.     Perhaps  this  is  not  the 


Chart  No.  39 

Straight    Leg   Walking    (After    Bradford). 

A — Toe  Walking.     B— Heel  Walking. 


reason  for  believing  that  the  weight  of  the  body  is  intended  to  fall 
upon  the  heel  in  walking,  but  it  is  admirably  adapted  for  sustaining 
the  weight  of  the  body  as  it  falls  and  is  transmitted  to  the  ground. 

When  one  has  taken  a  long  walk,  and  is  quite  fatigued,  there  is 
a  natural  desire  and  tendency  to  stand  with  legs  spread,  relaxing  the 


106  THE    HUMAN    FOOT 

muscles  of  the  legs,  and  on  doing  so  the  toes  are  thrown  outward, 
the  muscles  are  relaxed,  and  the  ligaments  through  their  stretching 
and  bracing  action  relieve  the  muscular  pressure ;  therefore,  it  is  seen 
that  the  ligaments  give  support  to  the  structures  when  the  body  is 
in  a  passive  state,  but  ligaments  are  not  adapted  for  a  prolonged 
strain,  and  whether  it  be  in  walking  or  prolonged  standing  they  must 
be  relieved,  otherwise  their  tone  and  strength  is  lost  and  flat  foot 
develops. 

I  have  often  had  the  point  raised  as  to  whether  the  well  formed 
feet  of  the  present  date  should  be  straight  on  the  inside  from  heel  to 
toe.  It  is  true  that  in  infancy  the  point  of  the  great  toe  projects  from 
the  other  toes,  so  that  a  straight  line  can  be  drawn  through  the  center 
of  the  great  toe  and  heel,  but  as  the  bones  form  and  develop  there 
is  an  enlargement  of  the  Tarsal  bones,  increasing  of  thickness  of  the 
foot,  owing  to  its  mechanical  covering,  the  shoe,  and  it  gradually 
assumes  a  more  pointed  shape.  Whether  or  not  a  shoe  built  over  a 
last  to  conform  to  the  theoretically  normal  foot  would  be  practical 
on  the  present  day  type  of  feet  of  adults,  who  for  many  years  have 
worn  pointed  shoes,  is  very  doubtful  because  it  would  require  a  re- 
building or  reforming  action  to  the  structures,  which  could  only  be 
accomplished  by  gradual  change  extending  over  a  long  period  of  time. 

The  mechanical  action  of  footwear  is  a  deep  study  and  one  which 
requires  close  observation  in  each  individual  case.  It  is  not  at  all 
difficult  to  interest  the  reader  on  a  subject  of  this  kind  who  recognizes 
that  upon  the  foot  depends  greatly  the  physical  well  being  of  the  body. 
When  one  considers  the  anatomy  and  physiology  of  the  body,  he  can 
readily  appreciate  the  close  relationship  of  the  feet  to  the  other  parts 
of  the  body — circulatory  and  central  nervous  systems  are  two  of  the 
important  parts  to  be  considered. 

This  can  readily  be  compared  with  the  consequences  arising  from 
cold,  wet  feet,  how  they  cause  discomforts  in  wear  and  tear  to  the 
body,  and  how  when  the  feet  give  rise  to  pain  and  discomfort  one  will 
decrease  his  daily  exercise  of  walking.  A  weakened  arch,  a  flat  foot, 
or  metatarsalgia,  and  all  of  these  conditions  give  rise  to  bodily  dis- 
comforts.    Nervousness,  stomach  disorders,  pelvic  disorders,  indiges- 


MECHANICAL    CONSIDERATION  107 

tion,  headaches,  spinal  deformities,  drop  shoulders,  rheumatics,  neu- 
ralgia, and  many  other  diseased  conditions  can  be  directly  traced  as 
caused  by  the  feet,  and  thus  one  who  is  making  a  study  of  the  feet  can 
feel  himself  a  humanitarian  by  providing  relief  and  correcting  any 
of  the  various  minor  foot  deformities  which  can  be  consistently  treated 
by  mechanical  means,  and  any  cases  which  he  cannot  properly  treat 
should  be  referred  to  the  physician  and  surgeon. 


CHAPTER    XVI 


EXAMINATIONS 

Believing  that  some  procedure  should  be  followed  in  making 
examinations,  in  order  to  facilitate  diagnosis  and  diminish  the  fre- 
quency of  errors,  I  have  outlined  the  following : 

If  in  the  shoe  store,  a  quick  examination  can  be  made  without 
removing  the  stocking,  although  for  accuracy  it  is  essential  that  it 
be  removed.  There  are  various  ways  of  detecting  foot  trouble  so  as 
to  be  able  to  impress  the  patient  that  you  are  capable  for  the  work. 

Inspection. — The  patient's  legs  and  feet  should  be  minutely  in- 
spected to  discern  the  following  abnormal  conditions :  a  limp,  abduc- 
tion of  the  foot,  wearing  of  the  shoe  over  the  Internal  Malleolus, 
prominence  of  the  Inner  Malleoli;  if  the  feet  are  parallel  or  divergent 
when  the  patient  stands;  if  the  soles  are  flat  on  the  ground,  or  are 
turned  upward;  if  any  of  the  joints,  especially  the  first  and  fifth 
Metatarso-Phalangeal,  is  prominent  through  the  shoe. 

Notice  if  the  inner  sole  of  the  shoe  is  smooth  or  contains  indenta- 
tions ;  if  the  sole  is  worn  through  at  one  point  while  scarcely  touched 
at  another;  if  the  great  toe  has  forced  a  cavity  or  opening  in  the  toe  of 
the  shoe,  because  too  short.  Another  positive  means  without  remov- 
ing the  stocking  is  by  palpation  over  the  Dorsum  and  Plantar  surface 
for  any  irregularities. 

History. — After  a  thorough  inspection  has  been  made  the  patient 
should  be  questioned  to  obtain  a  history  of  the  case :  information 
regarding  recent  illness  and  injuries;  the  occupation;  customary  use 
of  the  feet;  the  amount  of  dancing  and  participation  in  athletic  events, 
and  of  what  nature ;  how  long  ago  the  feet  were  well,  and  when  the 
present  trouble  began;  if  the  patent  was  ever  troubled  before,  and 
if  entirely  recovered;  if  the  complSnt  is  that  of  weakness,  or  fatigue, 
or  of  pain;  if  the  feet  burn;  if  the  pain  is  continuous  or  worse  at 

108 


EXAMINATIONS  109 

times ;  if  the  latter,  what  appears  to  influence  it ;  if  it  is  due  to  use  of 
feet ;  if  so,  of  what  kind  and  how  much ;  if  it  is  worse  in  the  night 
or  morning;  if  it  affects  one  or  both  feet;  if  one  was  affected  before 
the  other ;  if  they  are  both  affected  now.     Inquiries  of  the  family  or 


Chart  No.  40 

Manner  of  Examination  with  Stocking  Removed  and  Testing  for 

Weak   Foot  Condition. 


personal  history  should  be  made  in  order  to  determine  if  there  is  any 
trace  of  constitutional  diseases,  such  as  tuberculosis,  gonorrhea,  syph- 
ilis or  rachitis.  As  rheumatism  and  gout  play  an  important  part  in 
localized  foot  troubles,  inquiry  should  be  made  relative  to  previous 


110 


THE    HUMAN    FOOT 


treatment,  as  this  will  facilitate  in  determining-  what  treatment  the 
patient  requires. 

In  making-  complete  examinations  both  feet  and  legs  above  the  knee 
should  be  bared.    Then  the  shoes  should  be  carefully  inspected,  locat- 


Chart  No.  41 

Pointing  Out  Spreading  of  Foot  Between  First  and  Fifth  Metatarsal,  in  which  Case  the 

Support  is   Elevated   Between  the  Two   Points. 


ing  the  parts  most  worn  on  the  soles  and  heels  ;  noting  if  the  uppers  are 
stretched,  consequently  overlapping  the  heels  on  either  side;  if  the 
sole  on  the  inner  side  and  heel  are  on  a  straight  line;  the  height  of 
the  heel  should  be  compared  with  that  of  the  sole,  to  note  whether 


EXAMINATIONS 


111 


there  is  even  pressure  at  the  heel  and  at  the  ball  of  the  shoe,  and  if 
the  center  of  the  heel  is  under  the  center  of  the  weight-bearing  part 
of  the  foot.  As  stockings  are  a  common  evil  in  causing  foot  troubles, 
it  should  be  given  due  consideration,  thus  a  careful  examination  of 
them  should  also  be  made.  It  should  be  noted  if  they  are  damp ;  if 
they  are  pointed;  if  they  constrict  the  toes,  and  if  so  they  should 
be  drawn  away  from  the  Distal  end  of  the  Phalanges.  The  color  of 
the  skin  should  be  observed  to  determine  if  the  blood  supply  is  faulty. 
The  patient  should  then  be  told  to  stand,  and  the  position  of  the  toes 
noted  :  if  they  are  flat  on  the  ground,  flexed,  hyperextended  or  parallel ; 


Chart  No.  42 
Testing   for   Fiat-Foot. 


if  there  is  a  hallux  valgus ;  if  the  fore  foot  presents  a  flattened-out  ap- 
pearance ;  if  it  is  unusually  wide ;  if  there  is  a  concavity  or  a  bulging 
beneath  the  tuberosity  of  the  Scaphoid.  It  should  be  noticed  if  the 
Malleoli  are  well  defined,  and  if  the  outer  one  appears  to  be  in  its 
normal  relation  to  the  inner  one,  or  is  apparently  advanced. 


EXAMINATION  OF  THE  FOOT 

When  examined  from  behind,  does  the  Tendo-Achillis  run  in  a  ver- 
tical line  down  to  the  Os  Calcis,  or  does  it  deviate  to  one  side ;  are  the 
depressions  on  either  side  of  the  heel  cord  normal;  and  is  the  heel 


112  THE    HUMAN    FOOT 

spread  out  on  all  sides?  The  patient  should  be  asked  to  rise  on  his 
toes,  and  observed  if  it  is  done  easily  and  without  exertion.  It  should 
be  noticed  if  the  dome  is  heightened,  or  the  ankles  are  thrown  upward 
and  outward;  also  if  the  patient  can  stand  on  the  outer  borders  and 
invert  the  feet. 


Chart  No.  43 
Testing  for   Mobility   in  Tarsal   Region. 


PALPATION 


The  person  making  the  examination  should  be  seated  in  a  chair 
lower  than  the  one  in  which  the  patient  is  seated.  The  foot,  if 
only  one  is  complained  of,  should  then  be  placed  on  your  knee  in  such 
a  way  that  the  entire  leg  is  relaxed  and  in  a  comfortable  position. 
By  feeling  it  will  be  noticed  whether  the  local  temperature  is  normal. 
The  foot  should  then  be  examined  carefully  for  evidences  of  friction 


EXAMINATIONS  113 

or  uneven  pressure,  such  as  corns  and  callouses;  if  there  are  any  cal- 
losities present  under  the  fore  foot  and  are  they  beneath  each  one  of 
the  five  Metatarsals  or  beneath  only  the  middle  three ;  if  there  is  a 
callous  formation  along-  the  outer  border  of  the  foot,  or  around  the 
margin  of  the  heel;  if  there  is  a  bunion  over  the  first  Metatarso-Pha- 


Chart  No.  44 
Examination  Shows  Weak  Foot. 


langeal  joint,  and  also  for  ingrown  toe-nails;  the  condition  of  the 
circulation  of  the  foot.  In  a  normal  foot  the  lower  posterior  angle 
of  the  Internal  Malleolus  and  the  inferior  external  tuberosity  at  the 
head  of  the  first  Metatarsal  should  present  a  straight  line  connecting 
the  two  points  with  the  tuberosity  of  the   Scaphoid  slightly  above; 


114  THE    HUMAN    FOOT 

also  the  Tarsometatarsal  joint  of  the  first  toe  is  normally  at  middis- 
tance  of  the  inner  border  of  the  foot,  and  if  upon  measuring  it  shows  a 
lengthening-  of  the  posterior  half  it  indicates  a  lowering  of  the  arch. 
If  the  toes  are  deformed  they  can  be  straightened  by  passive 
movements.  The  motion  at  the  Medio-Tarsal  joint  can  be  ascer- 
tained if  the  Os  Calcis  is  firmly  held  in  one  hand,  with  the  tuberosity 
resting  in  the  palm,  and  grasping  the  bone  with  the  thumb  and  fingers 


Chart  No.  45 

Showing  How  Test  is  Made  for  Adhesions  About  the  Medio-Tarsal  Joint 

in   Cases  of  Fiat-Foot. 


to  arrest  its  movement,  then  with  the  other  hand  the  motion  can  be 
felt  by  manipulating  the  foot.  Inversion  and  eversion  can  also  be 
tested  by  holding  the  leg  firmly  above  the  ankle  with  one  hand  and 
with  the  other  grasping  the  Medio-Tarsal  joint,  manipulating  the  foot 
as  above. 

Xext  the  ankle  joint  should  be  tested,  and  in  order  not  to  be  mis- 


EXAMINATIONS 


115 


led  by  flexion  and  extension  at  the  Medio-Tarsal  joint,  the  foot 
should  be  firmly  held,  so  that  the  Os  Calcis  moves  at  the  same  time 
with  the  Metatarsals.  The  foot  should  then  be  moved  in  a  plane 
vertical  with  that  of  the  leg;  otherwise  abduction  in  Dorsal  flexion 
will  exaggerate  the  true  angle  of  flexion.  With  the  foot  in  a  position 
of  rest,  the  range  of  active  movement  of  all  the  joints  can  be 
determined. 

PAIN 

Although  pain  is  not  of  essential  importance  in  making  a  diagnosis 
of  a  normal  or  diseased  foot,  it  aids  materially  in  making  a  differen- 
tial diagnosis.  Therefore  painful  spots  should  be  definitely  located. 
Pain  that  is  caused  by  pressure  over  diseased  or  injured  bone  is 
usually  more  clearly  defined  and  more  readily  located  than  the  pain 


Chart  Xo.  46 

Heels   Worn    Down   on   Inside   Indicate 

Weak    Foot. 


from  pressure  on  a  strained  or  ruptured  muscle  or  ligament.  Muscles 
and  ligaments  that  are  strained  or  ruptured  are  always  painful  if 
stretched,  and  in  a  ligament  pain  is  produced  only  by  separating  the 
ends ;  but  contraction  will  produce  it  in  a  muscle.  When  there  is 
pain  upon  pressure  over  the  body  of  the  Os  Calcis  it  is  usually  due 
to  disease  or  injury  to  those  bones.  Pain  over  the  Peroneal  Tubercle 
on  the  external  surface  of  the   Os   Calcis   is   due  to  tension  of  the 


116  THE    HUMAN    FOOT 

synovial  sheath  of  the  Peroneal  tendon  dragging  it  away  from  its 
attachments  to  this  tubercle.  In  cases  of  everted  feet  the  pain  about 
the  External  Malleolus  is  due  to  a  crowding  of  the  tissues  against  the 
External  Malleolus  from  malposition  of  the  Tarsus.  Inflammation 
or  strain  of  the  Medio-Tarsal  joint  may  produce  pain  about  the  inner 
side  of  it.  Depressed  Metatarsals  in  cases  of  Morton's  Toe  or  Meta- 
tarsalgia,  where  pressure  of  walking  has  caused  irritation,  are  painful 
to  the  touch  and  each  one  should  be  examined  by  pressure. 


CHAPTER    XVII 


WEAKENED  FOOT 

Under  this  heading  I  will  endeavor  to  point  out  for  the  practi- 
tioner of  mechanical  orthopedics  certain  varieties  of  flat-foot  condi- 
tions which  I  have  found  to  be  most  prevalent,  and  I  will  commence 
by  pointing  out  the  weakened  foot  type  of  feet. 


Chart  No.  47 
Weak  Foot,  Although  when  Weight  is  off  Foot  Appears  Normal. 


Weak  foot  consists  of  only  a  slight  change  in  the  structures  when 
weight  is  placed  upon  the  foot,  and  this  condition  is  due  to  ligamen- 
tous causes.  There  is  an  abnormal  laxity  of  the  ligaments,  which 
permits  the  weight  as  it  is  thrust  into  the  foot  to  depress  the  Longi- 
tudinal arch  and  to  cause  a  slight  abduction  of  the  foot,  and  while 
.the  feet  controlled  by  the  muscles  and  connecting  tendons   are  ap- 

117 


118 


THE    HUMAN    FOOT 


parently  normal,  they  are  not  afforded  the  protection  against  strain 
for  which  the  ligaments  provide  when  they  are  normal.  Weakened 
foot  is  characterized  by  pain  and  sensitiveness  through  the  heel  and 
ankle  and  Internal  Malleolus.  There  is  a  burning  sensation  on  the 
sole,  and  the  patient  complains  of  the  toes  feeling  cramped,  of  swelling 
through  the  ankle,  aches  in  the  calves,  general  fatigue  and  bodily 
weariness  after  much  standing  or  walking. 


Chart  No.  48 
Testing   for   Weak   Foot. 


When  a  patient  stands,  the  foot  has  a  tendency  to  abduction,  and 
slight  pronation  is  present.  There  may  be  an  extreme  tendency 
towards  weak  ankles.  The  patient  may  complain  more  of  weak 
ankle  than  of  the  pains.  Walking  is  dispensed  with  as  much  as  pos- 
sible, and  a  constant  fear  of  stepping  on  pebbles  or  over  cobblestones 
is  always  present.  Shoes  are  soon  thrown  out  of  shape,  owing  to  the 
spreading  tendency  of  the  structures. 


WEAKENED    FOOT 


119 


This  acute  weakened  foot  condition  is  found  among  men,  women 
and  children,  and  especially  pronounced  among  growing  children  be- 
tween the  ages  of  eight  and  fourteen.  This  condition  is  very  infre- 
quently discovered  by  the  patient  before  the  latter  stage  of  flattened 
foot  develops.  When  weight  is  taken  off  the  feet  the  Longitudinal  arch 
assumes  a  practically  normal  position.  When  weight  is  placed  upon 
the  feet  the  degree  of  flattening  varies  considerably,  depending  upon 


Chart  No.  49 
Correcting  with  Foot-Eazer  Which  Should  be  Fitted  to  Contour  of  Arch. 


the  severity  of  the  weakened  condition  of  the  Longitudinal  arch.  In 
some  cases  the  arch  sinks  considerably.  In  others  there  is  only  a  slight 
sinking  in  the  posterior  region.  Again  there  is  a  marked  rotation  of 
the  foot  at  the  Astragalo-Scaphoid  region. 

Weak  foot  is  found  very  common  the  present  day  among  both 
sexes  of  all  ages  and  classes.  Those  who  have  made  radical  and 
frequent  changes  in  height  of  heels  are  more  susceptible,  due  to  the 


120  THE    HUMAN    FOOT 

ligamentous  strain,  but  an  immediate  change  in  the  height  of  the  heel 
is  to  be  avoided. 

Weak  feet  of  this  type  are  found  among  men  and  women  and 
growing  children.  When  weight  is  removed  from  the  foot  it  is  ap- 
parently normal,  but  when  the  patient  suffering  from  weak  foot  places 
his  body's  weight  on  the  foot  a  slight  elongation  and  forward  rota- 
tion takes  place. 

Women  who  wear  extremely  high  heeled  shoes,  and  who  do 
constant  standing  or  walking,  are  more  prone  to  this  disorder.  If 
•mechanical  treatment  is  resorted  to  at  once,  permanent  correction 
can  be  accomplished  by  means  of  an  arch  support.  The  arch  support 
should  be  very  carefully  fitted  so  as  to  correct  the  displacement  and 
weakness,  and  to  hold  the  foot  in  a  normal  attitude.  In  this  way 
ligamentous  strain  is  immediately  removed  and  the  muscles  given 
their  full  range  of  motion.  Care  should  be  taken  to  see  that  the  shoe 
worn  by  a  patient  is  of  sufficient  length  and  width. 

Treatment. — The  treatment  of  the  weakened  foot  condition  is  prin- 
cipally mechanical.  In  the  early  and  incipient  stages  pads  of  felt  or 
leather  may  give  relief,  but  are  objectionable,  as  they  depend  upon 
the  shank  of  the  shoe  for  their  base  of  support.  It  is  very  rare  indeed 
that  the  shank  of  a  shoe  will  provide  strength  enough  to  support  the 
padding  intended  to  hold  up  the  weakened  arch.  I  have  obtained  best 
results  with  the  foot-eazer  type  of  support,  which  is  light,  resilient 
and  easily  adjusted  to  accommodate  the  weakened  foot  and  restore 
and  permanently  hold  the  structures  until  the  ligaments  have  assumed 
their  natural  strength  and  tone.  For  weakened  foot  condition  the 
foot-eazer  or  arch  support  must  be  fitted  with  the  foot  held  in  its 
normal  relaxed  state  so  as  to  hold  the  foot  structures  permanently  in 
their  natural  position.  Relief  is  usually  immediate,  and  cure  is  effected 
in  three  to  five  months5  time.  Low-cut  shoes  are  to  be  advised 
against  if  ankles  appear  weak,  although  if  they  are  worn  the  arch 
supports  must  be  used  at  all  times.  Massage  and  tip-toe  exercises 
are  recommended  as  an  auxiliary  treatment. 


WEAKENED    FOOT 


121 


WEAK  FLEXIBLE  FOOT 

Of  the  many  disturbances  in  structural  and  weak  conditions  of 
the  foot  one  of  the  most  numerous  may  be  classified  under  the  above 
heading.  The  symptoms  of  pain  and  distress  are  practically  the 
same  as  weakened  foot  or  flat  foot,  although  the  change  in  contour  of 
the  arch  is  only  apparent  when  weight  is  placed  upon  the  foot.     In  a 


Chart  No.  50 

Weak,   Flexible,   High  Arched  Foot. 


relaxed  condition  the  shape  of  the  foot  is  normal,  the  Longitudinal 
arch  being  high,  and  is  usually  found  among  persons  who  have  been 
accustomed  to  wearing  moderately  high  heels.  The  position  of  the 
Tarsus  is  rather  contracted  to  admit  of  the  positioning  of  the  height 
of  the  heel.    This  gives  the  Longitudinal  arch  a  higher  curvature. 

The  peculiar  arrangement  of  the  bones  of  the  foot  that  make  up 
the  arch  where  the  weight  is  carried  and  the  adjustment  of  the  struc- 


122 


THE    HUMAN    FOOT 


tures  to  the  poise  of  the  foot  with  weight  upon  it  necessarily  produce 
extreme  pressure  to  the  Anterior  Transverse  arch.  In  weakness  of 
the  Longitudinal  arch  added  pressure  and  weight  are  thrown  forward 
and  upon  the  Anterior  arch. 

Symptoms. — The  foot  is  usually  soft  and  flexible.  By  grasping 
the  Os  Calcis  with  the  left  hand  and  producing  pressure  upon  the 
Anterior  Plantar  surface  the  foot  elongates  and  assumes  a  flattened 
position.  There  is  usually  a  complaint  of  weak  ankles,  fatigue,  pain 
and  tenderness  in  the  heel,  frequent  cramping  of  the  calf  muscles,  and 
a  sensation  of  discomfort  about  the  toes  as  though  the  shoe  had  insuf- 


Chart  Xo.  51 

Fitting  Foot-Eazer  to   Weak  Foot,  Arching  it  to   Give 

Correction  When  Walking. 


ficient  length.  There  is  a  burning  sensation  to  the  sole  or  ball  of 
the  foot  and  a  general  sensation  of  discomfort  due  to  swelling  through 
the  ankle  or  dorsum  of  the  foot.  Again  there  will  be  no  swelling  or 
localized  pain  present.  Many  persons  thus  afflicted  are  not  aware 
of  the  structural  weakness,  due  principally  to  the  fact  that  the  foot 
bears  no  appearance  of  abnormality. 

Treatment. — In  all  cases  of  weak  flexible  foot  the  first  essential 
is  to  restore  and  maintain  the  natural  balance  of  the  body's  weight 
as  transmitted  into  the  foot.  This  is  accomplished  by  fitting  arch 
supports  to  the  patient's  feet,  being  particular  to  make  adjustment  high 


WEAKENED    FOOT 


123 


enough  to  fit  the  inner  longitudinal  border,  creating  only  normal  pres- 
sure sufficient  to  maintain  the  natural  positions  of  the  bone  struc- 
tures. The  support  should  be  arched  from  a  point  commencing  at 
the  external  Cuneiform  inward  and  upward  to  the  inner  border  of 
the  arch,  touching  the  anterior  point  of  the  Os  Calcis,  the  lower 
facet  of  the  Astragalus,  Scaphoid,  and  the  inner  and  middle  Cunei- 
form. In  doing  so  ligamentous  strain  is  removed,  muscular  activity 
increased  and  normal  action  replaced.  For  this  condition  I  use  the 
tri-spring  arch  support,  or  foot-eazer,  which  must  be  carefully  fitted 


Chart  No.  52 
Pointing  Out  How  Weight  is  Thrown  Upon  First  Metatarsal  Joint 
Owing   to    Weakne'ss   of   Longitudinal   Arch. 


to  hold  the  heel  of  the  foot  well  back  in  the  heel  of  shoe  and  thereby 
prevent  spreading  and  elongating. 

In  these  feet  are  also  found  a  weakened  condition  in  the  Anterior 
arch,  due  probably  to  the  extra  pressure  imposed  upon  that  portion 
of  the  foot.  Care  should  be  taken  to  learn  whether  or  not  there  is 
any  slight  displacement  in  the  Anterior  arch,  and  if  found  an  Anterior 
Metatarsal  arch  support  should  be  fitted.  The  style  of  shoe  worn  by 
the  patient,  as  regards  heel  height,  should  not  be  changed,  although 
care  should  be  taken  in  advising  a  shoe  of  sufficient  length  and  width, 
with  snusr  fit  through  the  heel  and  waist. 


124  THE    HUMAN    FOOT 

ACUTE  WEAKENED  FEET 

Characterized  by  pains  and  sensitiveness  through  the  dorsum  of 
the  foot,  same  occurring  through  the  heel  and  ankle  and  at  the  Ex- 
ternal Malleolus.  In  these  cases  strips  of  zinc  oxide  adhesive  plaster, 
and  a  small  felt  pad  firmly  strapped  up  in  the  highest  point  of  the  arch 
to  serve  as  a  temporary  support,  should  be  used  in  the  beginning  of 
treatment.  After  a  short  time  a  light  weight  arch  support  properly 
fitted  should  be  applied.  In  any  condition  of  weakened  foot,  especially 
those  feet  poised  with  a  contracted  or  shortened  heel,  care  must  be 
taken  to  advise  the  patient  not  to  change  the  type  of  heel  previously 
worn.  The  shoes  are  to  be  fitted  closely  through  the  heel  and  waist  to 
afford  snug  fit  and  aid  in  supporting  the  weakened  foot. 


CHAPTER  XVIII 


FLAT-FOOT— BROKEN-DOWN  ARCH 

The  above  subject  is  also  known  as  valgus,  splay-foot,  pes  valgus, 
pes  planus,  talipes  valgus.  This  subject  must  be  of  intense  interest  to 
the  student  and  practitioner  alike,  as  full  use  and  restoration  of  these 
most  useful  members,  the  feet,  depend  upon  the  proper  diagnosing,  ex- 


CharT  No.    S3 
First  Condition  of  Flat  Foot,   Showing  the  Weakened  Condition. 


animation  and  treatment.  It  is  a  condition  so  commonly  found  among 
all  ages,  all  classes  and  both  sexes  that  there  should  be  a  constant 
watch  for  the  recognition  of  the  deformity.  The  flexibility,  the  grace- 
fulness and  the  general  health  of  the  physical  body  depend  greatly 
upon  the  watchfulness  and  care  in  the  proper  handling  of  these  cases. 
Flat-foot  would  indicate  from  the  description  of  the  term,  as  gen- 
erally used,  a  flattening  of  the  arch  or  sole  of  the  foot  with  all  the 

125 


126 


THE    HUMAN    FOOT 


pains  and  discomfort  due  to  a  broken-down  arch,  strain  or  abnormal 
condition,  which  would  be  diagnosed  as  flat-foot,  but  many  are  unable 
to  recognize  it  on  account  of  the  misleading  descriptive  phrase  and 
medical  term  generally  used.  Under  this  heading,  however,  we  would 
define  weak,  broken-down  arch,  flat-foot,  talipes  valgus,  etc.,  as  a  con- 
dition where  the  natural  arch  of  the  Plantar  surface  is  interfered  with, 
and  in  some  instances  partially  or  entirely  lost,  and  with  the  foot 
usually  everted  and  abducted  at  the  Medio-Tarsal  and  Sub-Astragaloid 


Chart  Xo.  54 
Acquired    Flat    Foot    in    Second    Stage. 


joints.  When  we  consider  again  the  anatomy  of  the  foot,  and  me- 
chanical construction  of  the  foot,  and  that  the  function  of  the  foot  is 
as  a  lever  to  raise  and  propel  the  body,  and  that  this  body's  weight 
must  be  maintained  by  its  particular  fulcrum,  it  can  be  more  easily 
understood  why  the  deformity  is  so  prevalent. 

Let  us,  therefore,  review  the  construction  of  the  Longitudinal  arch, 
or  the  inner  and  outer  Longitudinal  arch,  or  where  the  weight  is 
carried  into  the  foot,  and  remember  that  the  bones   of  the  foot  are 


BROKEN-DOWN  ARCH  127 

given  their  principal  support  by  the  ligaments  and  are  only  controlled 
by  the  muscles  and  their  attachments.  It  should  then  be  evident  that 
if  the  structure  is  insufficiently  supported  by  the  ligaments,  the  mus- 
cular power  must  be  insufficient  and  the  weight  of  the  body  cannot 
be  carried  and  properly  balanced  by  the  foot.  In  flat-foot  cases  the 
ligaments,  generally  on  the  inner  and  plantar  surfaces  of  the  bones, 
become  strained  and  stretched,  allowing  the  joint  surfaces  to  separate 
at  the  bottom  while  at  the  top  they  are  forced  together. 
Flat-foot  can  be  divided  into  four  distinct  conditions : 

First,  the  weakened  foot  just  described. 

Second,  the  acquired  flat-foot. 

Third,  the  congenital  flat-foot. 

Fourth,  the  traumatic. 

Of  these  four,  acquired  flat-foot  is  most  common.  I  could  describe 
many  varieties  under  the  heading  of  acquired  flat-foot,  but  with  illus- 
trations and  descriptions  will  endeavor  to  cover  the  subject  as  briefly 
as  possible. 

ACQUIRED  FLAT-FOOT 

In  the  first  place  I  shall  describe  the  form  due  to  long  standing, 
constant  walking,  weight-bearing  and  physical  deficiency,  which  is 
the  acquired  form  of  flat-foot. 

With  the  acquired  flat-foot  the  natural  springy  and  flexible 
action  of  the  foot  is  soon  lost,  and  the  patient  notices  the  inability  of 
constant  use  of  the  foot,  with  pain,  and  within  a  short  time  a  gradual  or 
complete  change  in  the  structure  takes  place.  There  is  not  always  a 
complete  flattening  of  the  arch,  but  always  a  slight  displacement  of 
the  Astragalus,  which  rotates  inward  and  downward  upon  the  Os 
Calcis,  depressing  its  anterior  and  internal  border  until  its  movement 
is  checked  by  the  ligaments  connecting  the  bones.  The  Scaphoid  is 
also  depressed,  causing  a  further  depressed  condition  of  the  arch, 
especially  in  the  more  severe  cases  where  the  entire  sole  of  the  foot 
touches  the  ground.    The  weight  being  transmitted  by  the  Tibia  upon 


128 


THE    HUMAN    FOOT 


the  Astragalus,  the  displacement  occurs  at  the  inner  Malleolus.  The 
ligaments  and  supporting"  muscles  become  stretched  and  weakened  so 
that  there  is  a  gradual  subluxation  of  the  various  articulations. 
Natural  motion  is  gradually  lost,  the  ankles  are  weakened,  and  by 
degrees  injury  is  done  to  the  articular  surfaces,  which  is  found  in  the 
thickened  periosteum  and  cartilage.     The  foot  is  considerably  length- 


en art  No.  55 

Severe    Case    of   Acquired   Fiat-Foot. 


ened  and,  on  ac    mr'  c  its  weakness,  also  spreads   in  width      The 

greatest  amount         p  sion,  however,  is  at  the  inner  border  of  the 

Longitudinal  arch.  -1  ch  is  due  to  the  depression  of  the  Astragalus 

inward  and  doi  Arcing  the  remaining  Tarsal  and  Metatarsal 

bones  forward,  while  .  ,  )s  Calcis  is  forced  downward  and  backward. 


BROKEX-DOWX  ARCH 


129 


There  are  several  degrees  of  acquired  flat-foot.  The  first  degree, 
or  the  incipient  stage  of  flat-foot,  is  where,  as  we  will  remember, 
the  displacements  of  the  arch  are  naturally  restored  when  the  patient 
is  seated,  and  when  weight  is  removed  from  the  feet.  The  latter 
condition  implies  that  undue  strain  has  been  placed  upon  the  ligaments 
rather  than  on  the  muscles. 


Chart  No.   56 
Acquired   Weakened    Foot,    Early    Stage. 


The  second  degree,  or  pronounced  flat-f-  'cen-down  arch, 

is  where  the  bones  of  the  arch  of  the  foot  c      sbfe.     /  displaced  and 
natural  restoration  of  the  arch  is  not  accomp1  when  the  patient 

is  seated  and  the  weight  is  removed  from  L.     In  this  condi- 

tion there   is   considerable   displacement  of  uie   bn   es  and  spasm  of 

9 


130 


THE    HUMAN    FOOT 


the  Feroneal  muscles,  and  by  the  displacement  of  the  bones  mus- 
cular action  is  interfered  with.  In  this  stage  it  will  be  noted  that 
the  normal  motion  of  the  foot  is  considerably  diminished.  There  is 
more  or  less  swelling-  of  the  foot,  and  a  slight  deformity  may  exist.    In 


Chart  No.  57 
Acquired  Flat  Foot. 


the  third  degree  the  deformity  is  accompanied  by  rigidity.  There  is 
more  bone  displacement  downward,  and  the  foot  assumes  a  flattened 
appearance.  The  patient  is  unable  to  raise  himself  on  tip-toes,  and 
has  the  characteristic  flat-foot  attitude  and  flat-foot  gait  in  walking. 


BROKEN-DOWN    ARCH 


131 


Under  this  heading  could  also  be  mentioned  the  extreme  rigid  or 
osseous  flat-foot,  in  which  condition  the  position  of  the  bones  has 
changed.  It  is  very  difficult  to  successfully  treat  these  cases,  and 
great  care  should  be  exercised  in  applying  mechanical  aid. 

Osseous  flat-foot  is  the  result  of  unrelieved  eversion  and  abduction  ; 
it  may  or  may  not  be  a  painful  condition,  but  when  it  becomes  firmly 


Chart  No.  58 
Acquired  Flat  Foot. 


established  and  there  is  no  movement  in  the  Intra-Tarsal  joints,  the 
pain  arises  from  uneven  Plantar  pressure.  As  all  the  finer  accommo- 
dating movements  are  lost,  the  bones  cannot  be  shifted  to  accommodate 
themselves  to  alterations  in  the  plane  of  the  body  containing  the  center 
of  gravity,  or  to  changes  in  those  surfaces  upon  which  the  foot  rests; 
therefore,  callouses  will  form  at  those  spots   receiving  the   greatest 


132 


THE    HUMAN    FOOT 


weight,  the  pain  conforming  to  the  extent  or  condition  of  these  cal- 
louses. In  this  deformed  condition  (which  is  a  true  flat-foot)  the  foot 
has  lost  all  of  its  normal  functions  except  that  of  support,  which  is  in- 
animate rather  than  physiological.     In  some  cases  the  pain  is  never 


Chart  No.  59 


Sole  Impression  of  Flat  Foot. 


Sole  Impression  of  Normal  Foot. 


severe,  and  in  other  cases  the  patient,  having  accommodated  himself  to 
this  condition,  is  unaware  of  the  existing  deformity. 

Upon  examination  will  be  found  a  prominence  at  the  head  of  the 
Astragalus,  Scaphoid,  and  at  the  Internal  Cuneiform,  which  is  due  to 
3.  partial  dislocation.     When  the  patient  stands  in  bare  feet  there  is  a 


BROKEN-DOWN    ARCH 


133 


decided  abduction   and  pronation,  and  usually  a  swelling  about  the 
ankle  and  dorsum  of  the  foot. 


Chart  No.  60 
Black   Spot   Shows  Location  of  Pain. 


The  arch  is  lowered  and  considerable  pressure  is  brought  to  bear 
upon  the  inner  border.  The  External  Malleolus  is  depressed  and 
points  forward,  while  the  Internal  Malleolus  becomes  more  prominent. 


Chart  No.  61 
Fiat-Foot,  with  Finger  Pointing  to  Callous  on  Great  Toe. 

Symptoms. — The  earliest  symptom  is  usually  a  sensation  of  dis- 
comfort, of  tire,  strain  and  general  fatigue ;  complaint  is  made  that  the 
shoes  previously  worn  do  not  feel  as  comfortable,  and  not  infrequently 


134 


THE    HUMAN    FOOT 


the  sufferer  purchases  various  styles  and  sizes  of  shoes,  seeking  relief. 
There  is  pain  in  the  heel  similar  to  stone  bruise.  There  is  a  dull  ache 
in  the  legs,  pain  in  the  knee  and  pains  extending  into  the  thigh,  hips 
and  back.  There  is  a  general  tired,  weakened  sensation  throughout 
the  body,  frequently  loss  of  ambition  and  ability  to  make  any  progress 
either  mentally  or  physically.  The  foot  feels  stiff  and  clumsy,  as  the 
finer  flexible  movements  are  completely  lost. 

The  patient   soon  finds  that  the  habit  of  walking  is  changed  to 
that  of  riding-  on  street  cars  or  motors.     The   feet  have  lost  their 


Chart  No.  62 
Showing  Weakened  Posterior  Arch. 


springiness,  and  there  is  a  general  nervous  disorder.  There  is  an 
enlargement  of  the  great  toe  joint;  corns,  cramped  toes  and  cal- 
louses appear;  the  feet  sometimes  feel  cold  and  numb,  as  the  circu- 
lation is  impaired.  Again  the  feet  perspire  excessively,  and  there  is 
a  desire  for  standing  on  one  foot  and  then  on  the  other,  also  a  desire 
to  place  the  feet  on  some  object,  as  the  round  of  a  ladder,  edge  of 
a  desk,  or  round  of  a  chair  in  an  endeavor  to  obtain  support. 

There  is  local  tenderness  and  swelling,  with  pain,  and  there  is  a 
change  of  gait  of  the  person ;  instead  of  a  quick,  alert  step,  there  is 
a  slow,   slovenly  and  dragging  walk.     Complaint  is  made  of  weak 


BROKEX-DOYVX    ARCH  135 

ankles.  Shoes  break  open  in  the  shanks,  soon  lose  their  shape,  and 
heels  are  worn  down  at  the  inner  border.  Often  the  sufferer  has  pains 
simulating  rheumatism  and  gout,  and  not  infrequently  diagnosed  and 
treated  as  such.  It  is  found  among  all  ages,  but  principally  those  who 
are  on  their  feet  long  hours  and  whose  work  or  habits  require  them 
to  remain  in  the  same  position.  It  is  observed  most  frequently  in 
the  following  occupations  :     Barbers,  bartenders,  porters,  clerks,  sales- 


Chaet  No.  63 
Severe  Case  of  Flat  Foot,  Rigid  Type. 


men,  painters,  plasterers,  laborers,  bookkeepers,  policemen,  motormen, 
street  car  conductors,  nurses,  etc. 

It  is  to  be  found  more  among  persons  who  stand  or  walk  slowly 
than  those  who  walk  rapidly.  This  is  probably  due  to  the  necessity 
of  obtaining  a  balance  to  the  body  in  a  tripod  position,  with  the  toes 
everted  or  abducted.  This  position  permits  an  unusual  strain  on  the 
ligaments  which  give  way. 

DIAGNOSIS 

The  most  authoritative  method  of  recognizing  or  diagnosing  is  by 
observing  the  attitude  of  the  patient  and  the  contour  of  the  foot. 
Again,  depressed  articulations  are  manifested  by  callouses  forming  on 
the  Plantar  surface,  sometimes  at  the  heel,  with  a  thickening  and 
roughening  of  the  skin,  callouses  at'  the  first  and  fifth  Metatarso-Pha- 


136  THE    HUMAN    FOOT 

langeal  joints,  and  callouses  along-  the  inner  border  of  the  great  toe. 
Callouses  at  the  latter  point  are  caused  by;  the  elongation  or  weakening 
of  the  foot,  throwing  dead  weight  and  pressure  on  the  distal  phalanges 
and,  in  the  endeavor  of  the  foot  to  assume  its  correct  attitude,  pressure 
and  irritation  from  the  insole  of  the  shoe  is  produced.  Have  the 
patient  stand  in  stocking  feet  and  notice  the  change  of  contour  with 
the  body's  weight  on  and  off  the  feet. 

In  the  examination,  also,  the  hand  should  be  inserted  into  the  shoe 
and  observations  and  examination  of  the  inner  sole  made  for  location 
of  depressions  caused  by  the  toes.  In  some  instances  the  ball  of  the 
foot  or  the  great  toe  causes  a  prominent  indentation  in  the  insole.  If 
the  symptoms  are  carefully  studied  and  observed  with  the  above  sug- 
gestions, there  will  be  no  difficulty  in  making  a  proper  diagnosis. 

CAUSES 

It  has  been  found  that  the  causes  are  principally  mechanical;  the 
strain  and  the  pressure  create  a  disturbance  resulting  in  a  weakness  of 
the  ligaments.  The  ligaments,  when  subject  to  a  continuous  strain, 
soon  yield,  so  the  causes  are  due  to  the  strain  produced  upon  the  liga- 
ments. With  the  ligaments  strained  unduly,  they  are  unable  to  hold 
the  bones  together,  thus  a  slight  separation  at  the  articulations  takes 
place,  which  in  turn  allows  the  bones  to  interfere  with  the  muscular 
action. 

Long  Standing. — Persons  who  have  to  stand  much  usually  stand 
in  an  attitude  of  rest,  with  their  feet  slightly  abducted.  In  a  form  of 
abduction  we  have  seen  that  the  inner  edge  of  the  foot  is  lengthened 
and  there  are  no  muscles  actively  contracting,  so  that  the  ligaments 
are  strained  to  their  utmost  in  their  endeavor  to  keep  the  bones 
in  their  properly  arched  position. 

Excessive  Weight  Carrying. — Those  who  carry  heavy  weights, 
such  as  bricklayers,  errand  boys,  mail  carriers,  ice  men ;  in  such  cases 
the  muscles  and  the  ligaments  have  to  support  heavy  weights  in  addi- 
tion to  the  weight  of  the  bodv. 

Illfkting,  Improperly  Made  Shoes. — Shoes  are  probably  responsible 


BROKEN-DOWN  ARCH  137 

for  many  cases  of  flat-foot.  They  may  be  termed  as  the  predisposing 
and  sometimes  as  the  existing  cause.  The  pointed  toe,  the  shoe  fitted 
too  short  and  narrow,  and  the  constant  changing  from  one  style  of 
shoe  to  another,  which  change  the  articulations,  have  a  tendency  to 
weaken  the  ligaments. 


Chart  No.  64 
Severe  Case  of  Fiat-Foot,  Acquired. 

Heavy  Weight  Persons. — In  obese  persons,  with  excessive  weight 
borne  upon  the  feet,  and  the  ligaments  and  muscles  in  a  generally 
weakened,  flabby  condition,  flat-foot  very  readily  develops. 

Rapid  Growth. — Children  between  the  ages  of  nine  and  fourteen, 
a  period  when  they  grow  rapidly  and  the  tissues  are  expending  their 
energy  in  progression,  have  little  to  spare  to  meet  the  extra  exertion 
thrown  upon  them,  and  weak  ankles  and  flat-foot  develop.  In  this 
age  flat-foot  is  very  frequently  associated  with  knock-knee  and  bow- 
legs. 


138 


THE    HUMAN    FOOT 


Short  Limb. — Persons  with  a  shortened  limb  caused  by  fracture, 
hip  disease  or  other  injury  usually  throw  more  weight  and  pressure 
on  the  one  foot,  producing  excessive  strain,  and  flat-foot  develops. 


Chart  No.  65 
Flat    Foot   in    Growing   Child. 


Convalescent  Patients.- — Those  convalescent  from  acute  and  serious 
illness,  find  the  structures  in  the  foot  unequal  to  the  pressure  of  the 
weight  imposed  upon  them  and  flat-foot  results. 


Chart  No.  66 

Attitude  of  Child  with  Flat  Foot,  Associated  with 

Bow   Leg. 


Locomotor  Ataxia. — Flat-foot  is  very  common  among  these  patients 
because  of  the  impairment  of  muscular  and  ligamentous  tone,  and  to 
the  method  of  walking.     They  usually  walk  with  a  short  rap  which 


BROKEX-DROWX    ARCH 


139 


tends  to  throw  the  posterior  part  of  the  Os  Calais  upward  and  the 
anterior  end  downward.  This  induces  a  gradual  sinking  and  inward 
and  downward  rotation  of  the  Astragalus,  from  which  flat-foot  results. 

Rickets. — Among  children,  flat-foot  due  to  rickets  and  general 
health  impairment,  is  very  frequently  noticed 

Gonorrheal  Rheumatism,  and  general  rheumatism,  cause  a  weak- 
ness of  the  muscles  and  structures  which  allows  the  arch  of  the  foot 
to  become  depressed. 

CONGENITAL   FLAT-FOOT 

Considerable  discussion  arises  over  the  correctness  of  congenital 
flat-foot.  Although  leading  authorities  disagree  considerably  on  the 
subject,  it  has  been  shown  that  many  cases  are  of  congenital  origin. 


Chart  No.  67 
Congenital  .flat-Foot. 


The  feet  of  new-born  children  are  fiat,  and  although  there  is  an  in- 
herent tendency  for  the  bones  to  develop  and  take  shape  and  position 
of  the  bones  in  the  well-formed  adult  foot,  it  is  not  until  the  child  is 
of  an  age  enabling  it  to  walk  that  any  noticeable  development  of  the 
arch  is  apparent.  This,  however,  can  be  explained  by  knowing  that, 
bone  formation  in  the  infant  is  undeveloped  but  the  heavy  paddings 


140  THE    HUMAN    FOOT 

of    fat    somewhat    deceive    the    eye    in    the    dourse    of    an    ordinary 
examination. 

Congenital  flat-foot  gives  little  or  no  inconvenience  to  the  patient 
other  than  the  ungainly  and  ungraceful  manner  of  walking.  The  foot 
is  abducted,  with  the  toes  widely  turned  out,  and  with  a  considerable 
lack  of  elasticity  and  springiness  possessed  in  the  normal  foot.  There 
is  a  shuffling,  dragging  gait,  and  the  foot  presents  an  appearance  very 
similar  to  that  of  acquired  flat-foot,  but  there  is  more  of  a  pronated 
position  and  downward  sinking  of  the  arch  and  less  rotation  of  the 
bones  at  the  Medio-Tarsal  joint.  Congenital  flat-foot  is  often  asso- 
ciated with  bunion  and  hallux  valgus  condition,  and  a  large  percentage 
complain  of  no  pain  or  disturbance  due  to  the  deformity.  Others, 
whose  history  would  indicate  they  were  of  congenital  origin,  com- 
plain of  rheumatic  pains  in  the  feet,  and  also  limbs,  which  most  fre- 
quently occur  during  their  later  years  of  life. 

In  some'  instances  the  weight  is  carried  upon  the  head  of  the  As- 
tragalus and  the  foot  is  quite  rigid.  A  form  of  ossification  having 
taken  place  between  the  joints,  these  feet  are  very  difficult  to  fit  with 
shoes,  and  cause  callouses  and  corns  to  form  from  the  friction  and 
pressure  of  the  shoe.  The  treatment  for  these  cases  is  practically  the 
same  as  for  acquired  flat-foot  in  the  more  advanced  degree.  Manipu- 
lations, or  massage,  and  forcible  correction  can  also  be  used  with 
success. 

TRAUMATIC  FLAT-FOOT 

This  type  of  flat-foot,  or  broken-down  arch,  is  usually  produced 
by  a  sudden  fall,  a  blow;,  or  Aveight  falling  on  the  instep,  jump- 
ing from  a  high  distance  on  to  the  feet ;  athletes  striking  on  their 
feet  in  such  a  manner  as  to  rupture  and  tear  the  ligaments,  severe 
sprains,  and  any  injury  where  the  arches  of  the  feet  have  been  forced 
into  the  flattened  position,  causing  displacement  of  the  bones  and 
complete  or  partial  rupture  of  the  ligaments  and  straining  of  the 
muscles. 

This  is  very  evident  in  cases  of  Pott's  fracture,  or  wdiere  Pott's 
disease  has  not  been  properly  treated.  There  is  usually  a  displace- 
ment of  the  foot  at  the  ankle  joint,  and  unless  properly  treated  in  the 


BROKEN-DOWN  ARCH  141 

early  stages,  the  weight  of  the  body  in  standing  and  walking  will 
further  strain  the  attachments  of  the  bones,  causing  a  severe  de- 
formity. 

There    is    a    thickening   of    the    skin    and    callouses    form    about 
the  Internal  Malleolus,  with  great  pain  when  use  of  the  foot  is  made. 


Chart  No.  68 
Traumatic   Flat  Foot,    Caused   by   Fall   From   a  Height. 


TREATMENT 

The  treatment  consists  in  restoring  the  bony  structures,  removing 
the  strain  and  pressure,  which  is  practically  the  same  as  under  the 
head  of  acquired  flat-foot,  excepting  that  more  direct  pressure  and 
complete  restoration  of  the  arches  can  be  made  with  the  aid  of  tri- 
spring  or  tru-span  arch  supports. 


CHAPTER  XIX 


TREATMENT  OF  FLAT-FOOT 

The  first  object  in  mind  is  to  remove  the  cause,  to  restore  the  foot 
structures  to  normal  condition.  The  natural  movements  of  the  foot 
must  be  restored  and  maintained.  Further,  it  is  necessary,  owing;  to 
the  weakened  condition  of  the  ligaments,  which  are  unable  to  hold  the 
bones  in  their  proper  position,  that  the  arch  be  supported  until  this  ob- 


Chart  No.  69 

Foot-Eazer  Type  of  Mechanical  Treatment  of  Weak  Foot 

Applied  to  the  Foot. 

ject  has  been  attained.  This  method  is  known  as  mechanical  treat- 
ment. Other  treatments  are  bandaging  with  adhesive  plaster,  manipu- 
lating and  massaging,  exercise,  complete  rest,  forcible  correction  (re- 
quiring hospital  treatment),  placing  the  feet  in  plaster  of  paris  casts 
and  operation  or  surgical  treatment.  Of  these  varieties,  mechanical 
treatment  is  most  successful  because  of  the  fact  that  persons  with  flat- 
foot  are  usually  very  active  on  their  feet,  and  it  would  be  impossible 

142 


TREATMENT    OF    FLAT-FOOT 


143 


Chart  No.    70 
Shoe  Showing  Effect  of  Flat  Foot  or  Weakened  Foot  Where  Pads 
Have  Been  Used. 


Chart  No.    71 

Same   Shoe  in  Which  Metal   Support  Bridges  Weight   from  Heel 

Over  Shank  of  Shoe. 


144  THE    HUMAN    FOOT 

to  give  the  medical  or  required  hospital  treatment  to  effect  a  per- 
manent cure.  From  my  observations  I  have  found  numerous  cases 
treated  by  forcible  correction,  use  of  plaster  casts,  and  also  rest  cure, 
where  pronounced  symptoms  of  the  former  trouble  would  return  upon 
active  use  of  the  feet. 

I  have  also  known  similar  cases  that  have  been  subjected  to  me- 
chanical treatment,  and  have  received  immediate  relief.  Eventually 
the  feet  have  been  completely  restored  to  usefulness,  and  this  condi- 
tio m  permanently  maintained. 

The  vast  number  of  sufferers  from  this  malady  makes  it  important 
that  a  means  of  treatment  be  resorted  to  which  will  give  quick  relief 
in  removing"  the  cause  of  pain  and  inability  to  use  the  feet,  and 
gradually  restore  the  foot  to  normal  without  the  loss  of  time  to  the 
patient.  With  a  properly  constructed  and  fitted  mechanical  appli- 
ance we  have  a  wonderful  therapeutic  agent,  first,  giving  relief; 
second,  removing  the  cause ;  third,  gradually  rebuilding  the  structures ; 
fourth,  stimulating  muscular  action  and.  fifth,  permanently  correcting 
the  deformity. 

Owing  to  the  vast  number  of  theories  advanced  on  what  the  proper 
support  should  consist  of.  I  will  briefly  bring  out  what  I  consider  the 
essentials  in  a  mechanical  aid  for  foot  treatment,  and  I  may  mention 
in  so  doing  that  the  appliances  invented  by  myself  have  been  used 
with  great  success  in  my  own  practice,  and  that  of  other  leading 
physicians  and  surgeons. 

First.  The  appliance  must  be  one  that  will  give  support  and  cor- 
rection to  the  foot  quite  independent  of  the  shank  of  the  shoe. 

Second.  It  should  be  constructed  on  anatomical  and  orthopedic 
principles. 

Third.  It  must  be  made  of  a  material  non-corrosive  and  non- 
rusting. 

Fourth.  It  must  be  constructed  of  a  material  and  design  which 
wdl  permit  the  most  minute  adjustments  to  the  requirements  of 
individual  cases. 

Fifth.  It  must  be  of  the  correct  width  and  length  to  support 
the  Plantar  surface  of  the  foot,  and  yet  not  interfere  with  the  needed 
movements  at  the  Metatarso-Phalangeal  junction. 


TREATMENT    OF    FLAT-FOOT 


145 


Sixth.  It  must  be  so  constructed  that  it  can  be  worn  in  the 
regular  type  of  shoe  without  destroying  its  shape,  and  the  stock  sup- 
port must  be  made  in  a  range  of  sizes  enabling  quick  and  easy  fitting 
and  adjustment. 

Seventh.  It  must  not  be  heavy,  rigid  or  cause  a  feeling  of  encum- 
brance to  the  patient. 

Eighth.  It  should  be  made  of  light-weight  materials  for  the  light- 
weight person  in  incipient  conditions,  and  more  substantial  for  the 
heavy-weight  persons  with  more  developed  conditions.  With  these 
essentials  in  mind  I  have  carried  out  the  construction  of  three  models. 
First,  a  support  made  with  the  full  supporting  plate,  having  a  rein- 


Chart   No.    72 
Tri-Spring    Arch    Support. 


forcing  spring  attached,  which  consists  of  an  additional  spring 
doubling  upon  itself  in  the  center  of  the  arch,  forming  a  triple  spring. 
The  supporting  surface  of  the  tri-spring  arch  support  differs  from 
most  arch  supports  in  that  the  elevation  of  the  inner  border  is  more 
acute  and  is  designed  to  supply  greater  force  and  elevation  directly 
beneath  the  Astragaloid  region.  It  has  an  inside  flange  and  is  leather 
covered  to  make  fitting  more  convenient  and  to  prevent  displacement 
in  the  shoe.  The  outer  surface  of  the  plate  extending  under  the 
outer  Longitudinal  arch  is  made  lower,  so  as  not  to  cause  any  pres- 
sure at  that  point. 

This    support    is    indicated    in   the   weak   foot,    the   acquired,    the 
congenital  and  traumatic  types  of  flat-foot.     It  should  be  constantly 
10 


146  THE    HUMAN    FOOT 

borne  in   mind   that  the   success   of  the  appliance   depends   upon   its 
careful  adjustment  and  fitting. 

For   the   weak  foot   and   the   incipient    stage   of   flat-foot,    and   in 
those   cases   of   acquired   flat-foot   in   their   secondary   degrees   where 


Chart  No.  73 
Surgical  Insole  Plate  for  Flat-Foot. 


there  is  considerable  sensitiveness,  I  use  a  double-spring  constructed 
device  made  of  springy  German  silver  or  silveroid  so  constructed 
that  the  top  spring  is   free  at   the  forward   end,   permitting  a  back- 


Chart  No.  74 
Surgical  Insole  Plate  with  Anterior  Metatarsal  Elevation. 

ward  or  sliding  motion  to  the  under  or  supporting  spring  and  afford- 
ing resiliency,  which  is  most  beneficial  in  the  rebuilding  of  the 
weakened  and  deficient  arch.     The  forward  motion  permits  of  assist- 


Patented  self  adjusting  feature"^  ^p~ 

Friction  of  Foot-Fazer  top  plate  is  on  under  spring 
Chart  No.  75 
Foot-Fazer  for  Weakened  Arch,  Incipient  Flat  Foot  and  Sensitive  Feet. 

ing  the  articular  action  of  the  Anterior  Metatarsal  and  Phalangeal 
articulations,  and  I  use  this,  which  is  known  as  my  foot-eazer,  for 
flexible  weak  foot,  for  weakened  foot  and  acquired   flat-foot.     It   is 


TREATMENT    OF    FLAT-FOOT 


147 


especially  recommended  for  the  early  stages  where  there  is  only  a 
slight  impairment  of  the  ligaments  noticeable,  and  where  there  are 
symptoms  of  weak  foot  development.     The  advantages  I  find  in  this 


Chart  No.  76 
Tru-Span  Arch   Support  for  Severe  Cases. 


device  are  in  its  furnishing  a  quick  and  easy  means  of  removing  the 
strain  and  restoring  the  balance  and  equilibrium  to  the  foot  without 
resorting  to  the  extreme  measure  in  recommending  change  of  shoes  or 


Chart  No.  77 
Showing  Tri-Spring  Arch   Support  Fitted  to  Foot. 


requiring  readjustment  to  the  modes  of  walking.  With  the  early 
symptoms  of  fatigue,  cramping  toes,  aches  and  pains  through  the  foot, 
a  support  which  is  easily  adjusted  will  give  immediate  relief  and  re- 


148 


THE    HUMAN    FOOT 


store  the   foot  so  that  the  device  may  be   discarded  within   a  com- 
paratively short  time. 

In  the  extreme  rigid  and  osseous  flat-foot  and  for  severe  cases 
where  considerable  resistance  must  be  met,  I  construct  a  plate  with  a 
short  depressed  opening  in  which  I  insert  a  further  strengthening 
plate,  assembling  the  two  to  aid  in  furnishing  the  necessary  support. 
This  I  term  as  tru-span,  which  I  find  most  useful  in  the  severer  cases, 
And  these  three  patterns,  with  the  Anterior  Metatarsal  arch  support, 


Chart  No.  78 
Tru-Span   Arch    Support   for   Heavy  Weight   and    Severe   Cases. 


afford  the  armamentary  for  all  valgus  conditions  of  flat-foot.  These 
appliances  are  made  of  material  that  will  permit  the  adjustment  to 
each  and  every  case,  and  which  are  undisputably  necessary  elements 
in  the  correction  of  foot  troubles. 

As  the  subject  of  adjustment  is  a  very  important  one  in  the  treat- 
ment of  foot  deformities  by  mechanical  appliances,  I  have  written 
a  special  chapter  showing  how  these  appliances  are  adjusted  to  meet 
the   requirement  of  each   individual   case.      When   the   supports   are 


TREATMENT    OF    FLAT-FOOT 


149 


properly  fitted  they  should  cause  no  discomfort  and  relief  should  be 
immediate,  as  the  foot  is  held  in  a  corrected  position  and  the  support 
becomes  a  positive  aid  in  effecting  a  physiological  cure.  The  length 
of  time  required  to  effect  a  cure  depends  upon  the  case,  advancement 
of  the  weakness,  mode  of  walking  and  the  style  of  shoe  worn.  Great 
care  must  be  exercised  in  advising  that  the  shoe  be  of  correct  length 
and  shape,  snugly  fitted  through  the  waist  and  heel.  Modified  heels 
are  recommended  where  the  patient  has  not  become  thoroughly 
accustomed  to  an  extreme  hisrh  heel,  in  which   event  the  height  of 


Chart  Xo.  79 

Showing  How  Weak  Foot  is  Supported  with  Foot-Eazer  without  Depending  on 

Shank  of  Shoe.     Xote  How  Foot  is  Drawn  Back  and  Held  in  Position. 


the  heel  should  be  gradually  lowered.  The  supports  are  best  fitted 
to  the  foot  of  the  patient  and  adjustments  made  regularly  until  a 
cure  is  effected.  These  appliances  may  also  be  fitted  to  outlined  or 
penciled  diagrams  of  the  feet,  which  may  be  taken  by  having  the 
patient  seated  with  a  sheet  of  paper  placed  under  both  feet  on  the 
floor,  and  pencil  outline  drawn  around  the  foot.  Then,  without  lift- 
ing the  foot,  have  patient  stand  with  entire  body  weight  on  the  feet 
and  a  second  drawing  made  around  the  foot,  indicating  thereon  any 
prominence  as  Rotated  Astragalus,  extreme  Pronation,  long  or  short 
heel.     Then  a  line  is  drawn  between  the  first  Metatarso-Phalangeal 


150 


THE    HUMAN    FOOT 


joint  to  the  fifth  Metatarso-Phalangeal  joint  on  the  diagram.  The 
support  is  then  fitted  to  accommodate  these  lines.  In  no  instance 
should  these  appliances  be  fitted  according  to  shoe  size.  They  may  be 
fitted  and  also  made  over  plaster  paris  casts  taken  of  the  foot.  I 
have  allotted  a  complete  chapter  on  how  to  take  plaster  casts  so  that 
the  student  may  have  full  directions  before  him  in  the  event  that 
these  should  be  necessary.  Read  carefully  Chapter  XXI  on  fitting  of 
appliances. 


Chart  No.  80 
Method  of  Strapping  for  Flat  Foot,   Single  Strap. 


Bandaging  and  Strapping. — While  the  use  of  bandaging  and  strap- 
ping is  not  practical  for  general  use,  in  some  instances  of  acute 
attacks  adhesive  plaster  bandages  can  be  successfully  used.  This  is 
done  by  first  having  the  patient  seated  and  placing  the  foot  on  a  stool, 
•with  the  foot  abducted,  over-corrected;  a  strip  of  plaster  14  to  16 
inches  long  and  2  to  3  inches  wide  is  applied  to  the  outer  side  of 
the  ankle  just  below  the  External  Malleolus.  The  foot  is  again  care- 
fully abducted  and  corrected,  and  the  plaster  is  then  drawn  tightly 


TREATMENT    OF    FLAT-FOOT  151 

beneath  the  sole  and  up  over  the  inner  border  of  the  arch  and  attached 
to  the  inner  side  of  the  leg.  A  second  plaster  strip  may  be  applied 
in  the  same  manner,  and  then  with  narrow  bandages  this  is  stayed 
in  place.  This  is  sometimes  used  in  the  early  stages  and  worn  from 
five  to  ten  days,  after  which  an  arch  support  is  properly  fitted.     Great 


Chart  No.  SI 
Method  of  Strapping  for  Weak  or  Flat  Foot,  Double  Strap. 


care  must  be  taken  in  applying  the  bandages,  otherwise  the  restoring 
action  and  articulation  will  be  impeded.  This  method  is  also  used 
by  placing  a  felt  valgus  pad  in  position  beneath  the  arch  and  held 
in  place  by  similar  bandages. 

Exercises. — Certain  exercises  mav  be  used  after  the  early  stages 


152  THE    HUMAN    FOOT 

of  weak-foot  development,  which  are  often  beneficial.  The  object  of 
exercising  is  to  develop  muscular  action  where  there  is  a  deficiency, 
but  not  until  the  ligamentous  causes  have  been  removed  by  proper 


Chart  No.  82 
Method  of  Bandaging  with  Strapping  for  Severe  Flat  Foot. 


mechanical  treatment.  Inverting  the  feet,  that  is,  standing  with  toes 
in,  and  rising  on  tiptoes  ten  to  fifteen  times,  first  very  slowly  and  then 
more  rapidly  as  soon  as  accustomed,  and  extending  and  flexing  the 
toes,  are  also  very  helpful  in  restoring  foot  action. 


CHAPTER    XX 


METATARSALGIA— MORTON'S    TOE 

Weakened   Transverse   Arch. — This   condition   occurs   in  the  An- 
terior Metatarsal  arch,  or  what  is  known  as  the  Anterior  Transverse 


Chart  No.  83 
Case  of  Metatarsalgia  Showing  Callouses  on  Sole. 

arch,   which   is   formed   by  the   Metatarsal   heads    and   consists   of   a 
dome-like   shape  between   the   first   and   fifth   Metatarsals.     The   de- 

153 


154 


THE    HUMAN    FOOT 


formity  consists  of  a  slight  displacement  or  depression  of  one  or  more 
of  the  Metatarsal  heads,  and  while  there  may  be  no  particular  dis- 
placement in  the  early  stages,  there  is  a  weakened  condition  in  the 
supporting  ligaments  which  permits  slight  displacements  in  walking, 
or  when  weight  is  thrown  upon  the  foot. 

Morton's   Toe   and    Morton's    Neuralgia   were   first   described   by 
Morton  of  Philadelphia.     Other  typical  cases  of  this  painful  affection 


Chart  No.  84 

Finger  Points  to  Usual  Location 

of  Pain. 


of  the  foot  occur  with  severe  pain  and  a  sudden  cramp-like  sensa- 
tion between  the  third  and  fourth,  or  fourth  and  fifth  Metatarso- 
phalangeal articulations.  The  pain  may  begin  with  burning,  tender- 
ness and  swelling,  extending  through  the  Dorsum  of  the  foot,  and  it 
frequently  extends  to  the  extremity  of  the  toe  and  up  to  the  foot 
and  leg.  In  some  cases  the  pain  is  preceded  by  a  sensation  of  slipping 
or  moving  of  the  joint.     Again  it  is  of  a  mild  character,  and  in  the 


MORTON'S    TOE  155 

severe  cases  the  cramp-like  pain  comes  on  with  such  suddenness  and 
severity  that  the  sufferer  is  compelled  to  remove  the  shoe,  compress 
the  foot  and  relieve  the  pain  by  extending  the  toes  and  by  manipula- 
tion to  relieve  the  cramp.     It  is  by  continued  stretching  of  the  capsular 


Chart  No.  85 

Outline    of    Foot,    with    Depressed 

Metatarsals  and  Callouses. 


ligaments  that  the  sensitive  synovial  ends  of  the  bones  are  uncovered 
and  exposed  to  pressure.  The  pain  and  excruciating  cramp  are  caused 
by  the  impingement  of  a  branch  of  the  digital  nerve. 

As  our  anatomy  shows  us  the  protective  tissue  over  the  Metatarsus 


156 


THE    HUMAN    FOOT 


is  very  thin  and  a  giving-  way  of  the  Anterior  arch  at  this  point 
results  in  many  cases  of  the  joints  becoming  permanently  and  partially 
dislocated  and  displaced.  With  the  giving  way  of  the  Anterior  arch 
undue  weight  is  thrown  upon  the  displaced  and  frequently  dropped 
Metatarsal  heads,  causing  callosities  to  form  and  the  resulting  burn- 
ing sensation  on  the  sole  of  the  foot  between  the  first  and  fifth 
Metatarsals.     There  is  also  a  thickening  of  the  anterior  part  of  the 


Chart  No.  86 

X-Ray     of     Weakened     Anterior     Transverse     Arch 

Showing    How     It     is     Spread    Laterally. 


foot  and  usually  manifested  by  severe  hallux  valgus,  overlapping  toes, 
enlargement  at  the  first  and  fifth  Metatarsals  and  the  formation  of 
corns  on  the  top  of  the  distorted  toes.  These  conditions  are  found 
more  frequently  among  women  than  among  men,  partially  due  to  the 
fact  that  shoes  with  narrow  toes,  tight  across  the  anterior  part  of  the 
foot,  higher  heels  which  force  the  foot  into  a  wedge-like  shape,  all 
have  weakening  effects  on  the  foot  structures.     Again,  in  some  in- 


MORTON'S    TOE 


157 


stances,  history  would  denote  that  it  is  a  family  inheritance ;  the  affec- 
tion is  usually  extremely  chronic  with  recurring  pains,  the  cramp- 
like attacks  coming  at  the  most  unexpected  time.  This  condition  is 
without  doubt  the  most  prevalent  of  any  foot  disorder,  yet  one  which 
is  rarely  recognized  until  the  severe  stage  of  pain. 


Chart  No.  87 

X-Ray  Print  Showing  Metatarsal^  and  Spreading 

of   the   Fifth    Metatarsal    Bone. 


In  this  condition  weak  ankles,  loss  of  balance,  weakened  Longi- 
tudinal arch  and  elongated  foot  are  also  found.  In  some  cases  the 
concavity  of  the  Transverse  arch  is  entirely  absent,  so  that  a  prominent 
convexity  is  formed  with  callouses  covering  the  entire  area.  It 
usually  occurs  in  one  foot,  but  sometimes  in  both  feet.  There  is 
numbness  and  swelling  and  local  pain,  and  temperature  may  be  present 


158  THE    HUMAN    FOOT 

with  severe  pain  following  through  the  foot,  leg,  thigh  and  back. 
When  weight  is  borne  upon  the  foot,  the  foot  elongates,  widens  and 
spreads,  and  weight  is  then  thrown  upon  the  weakened  or  displaced 
Metatarsal,  which  may  be  the  third,  fourth  or  fifth.  Upon  examina- 
tion will  be  found  redness,  tenderness  and  callosities ;  sometimes  in 


Chart  No.  88 
Metatarsalgia,   with   Painful    Callouses   and   Ulcerations. 

spots,  or  sometimes  in  small  areas  ■  covering  one  or  more  of  the 
Metatarsal  heads;  oftentimes  the  tissues  seem  to  be  dense  and  offer 
more  protection,  but  with  the  toes  contracted  and  dorsiflexed. 

In  a  few  cases  small  bony  enlargements  have  projected  from  the 
heads  of  the  Metatarsal  bones,  and  in  others  fibrous   growths  have 


MORTON'S    TOE 


159 


been  found  in  the  subcutaneous  tissues.     In  any  event  it  is  the  cause 
of  weakness,  strain,  pressure  and  dislocation  or  displacement. 

Diagnosis. — Diagnosis  of  this  condition  is  first  usually  recognized 
by  the  description  given  by  the  patient  and  history  of  the  case. 
Cases  where  there  has  been  an  impingement  of  the  Digital  nerves,  or 
where  the  cramps  and  pains  have  been  sudden  and  severe,  to  make 
examination,  the  heel  should  be  grasped  by  the  left  hand  and  with 
the  toes  extended,  pressure  produced,  and  a  test  made  for  mobility  of 


Chart  Xo.  89 
Aletatarsalgia   with    Pronounced   Thickening  Due  to 
Depressed  Metatarsals. 


the  foot;  then  with  both  hands,  with  the  foot  still  at  rest,  cause  pres- 
sure to  the  Metatarsals  with  the  thumbs.  (Charts  Xos.  91  and  93.) 
Make  a  test  to  discern  whether  the  natural  dome-like  arch  is  lost, 
and  to  locate  the  positioning  of  the  depressed  Metatarsals ;  as  the 
greatest  average  of  pain  is  found  between  the  fourth'  and  fifth  Metatar- 
sals the  examination  must  be  very  carefully  made  in  this  region.  If 
the  toes  assume  a  cramped,  dorsiflexed  position,  or  appear  to  be  con- 
tracted, there  is  usually  a  marked  prominence  of  the  muscles  and 
tendons   of  the   Dorsal   surface,    and   there   is    external   indication    of 


160 


THE    HUMAN    FOOT 


irritation  at  the  base  of  the  fifth  Metatarsophalangeal  joint,  and 
usually  redness.  If  the  shoe  worn  by  the  patient  is  examined  it  will 
be  found  that  the  upper  leather  spreads  considerably  over  the  sole, 


Chart   No.    90 

Black  Spot  Indicates 

Location  of  Cramp 

and  Severe  Pain. 


Chart   Xo.    91 

Showing   Where    to 

Test    Anterior 

Arch. 


and  that  the  sole  at  the  tread  is  worn  very  unevenly.  This  is  brought 
on  by  the  widening  and  thickening  at  the  ball  of  the  foot.  In  many 
cases  the  examination  would  show  a  normal  foot  other  than  the  weak- 


MORTON'S    TOE 


161 


ness  apparent  when  weight  is  placed  upon  the  foot  and  a  spreading 
noticed  between  the  first  and  fifth  Metatarsals.  (See  outline  diagrams, 
Chart  No.  92.) 

One  of  the  most  usual  symptoms  for  diagnostic  purposes  is  the 
contour  at  the  Anterior  arch,  cramped  toes  and  thickening  of  the  sole 
with  callouses.  This  condition  is  found  among  men,  women  and 
growing  children. 


Chart  No.  92 
Showing  Abnormal  Spreading  and  Widening  Between  AA  and  En- 
largement   at    First    and    Fifth    Metatarsal    Joint.      Lines    BB    Show 
How    Foot   is   Made    Narrower   when   Transverse   Arch   is    Supported. 


Treatment. — The  treatment  indicated  in  these  cases  is  mechanical. 
Surgical  operations  are  very  rarely  resorted  to.  The  treatment  should 
be  of  a  local  order,  with  an  object  in  view  of  restoring  the  weakened 
structure  and  replacing  the  displaced  Metatarsals.  This  is  best  accom- 
plished by  an  arch  support  especially  constructed,  with  its  object  to 
remove  all  strain  and  pressure,  to  maintain  the  natural  balance  by 


11 


162 


THE    HUMAN    FOOT 


supporting  the  Longitudinal  arch  thoroughly,  and  giving  the  right 
adjustment  to  the  Anterior  arch.  The  appliance  which  I  have  used 
since  1906  for  this  purpose  is  known  as  my  Anterior  Metatarsal  arch 
support,  which  is  constructed  of  a  light-weight  silveroid  alloy  metal, 
peculiarly  shaped  to  fit  the  heads  of  the  Metatarsals,  having  a  wide 


Chart  No.  93 
Testing  Foot  for  Anterior  Arch  with  Thumbs. 


bearing  point  and  a  dome-like  curvature  between  the  first  and  fifth 
Metatarsals.  The  success  of  this  support  lies  in  the  adaptability  to 
the  various  conditions  found  in  each  individual  case,  which  must  serve 
to  firmly  support  the  Longitudinal  arch,  thereby  removing  consider- 
able weight  and  pressure  from  the  Anterior  arch.     The  plate  must  be 


MORTON'S    TOE 


163 


Chart  No.  94 
Applying  Anterior  Metatarsal  Arch    Support  with   Flange  to   Foot  for   Size. 


Chart  Xo.  95 
Anterior   Metatarsal   Arch    Supports   in   Three   Patterns. 


164 


THE    HUMAN    FOOT 


of  a  full  length,  or  nearly  a  full  length  from  a  point  }i  inch  back  of 
the  Metatarso- Phalangeal  articulation,  extending  back  to  the  heel ; 
the  degree  of  elevation  to  the  Anterior  arch  depends  upon  the  condi- 
tion of  the  foot.  In  mild  cases  restoring  the  natural  dome  of  the 
Transverse  arch  is  sufficient.  In  other  cases  an  added  elevation  must 
be  produced  directly  behind  the  displaced  Metatarsals.  Again  it  be- 
comes necessary  to  produce  an  elevation  egg  shaped,  the  size  of  a 
walnut,   which   has   a  tendency  to  tighten  the   ligaments   controlling 


Chart  No.  96 
Anterior  Metatarsal  Arch  Support,  Fitted  One  with  Stocking,  Other  Without. 


the  Anterior  arch.  Care  must  be  taken  in  fitting  and  adjusting  the 
arch  supports  for  these  cases. 

In  the  milder  cases  of  callosities  I  use  my  Anterior  Metatarsal 
arch  support  with  the  flange,  and  in  incipient  cases  I  use  an  Anterior 
Metatarsal  arch  which  is  so  constructed  as  to  give  support  only  to 
the  Transverse  arch  in  the  anterior  region. 

Occasionally  a  felt  padding  with  kiro  pads  and  a  band  of  adhesive 
plaster  drawn  around  the  waist  of  the  foot  will  give  temporary  aid. 
Mechanical  supports,  however,  are  usually  more  satisfactory  because 
they  do  not  rely  upon  the  shoe  for  a  base  of  support  or  strength,  as 


MORTON'S    TOE 


165 


would  be  the  case  with  felt  or  leather  paddings.  Paddings  attached 
to  the  inner  sole  of  the  shoe  have  also  been  used,  but  are  not  so  success- 
ful because  of  the  serious   difficulty  in  properly  arranging  the  pad. 


Chart  No.  97 

Kiro    Pad    for   Giving   Mild    Suppor) 

to  Transverse  Arch. 


Then  again  in  many  instances,  owing  to  weakness  of  the  Longitudinal 
arch,  the  position  of  the  Anterior  arch  changes  considerably  in 
the  process  of  walking,  and  when  my  Anterior  Metatarsal  arch  sup- 


Chart  No.  98 
Padding   with   Felt   Kiro   Pads   and  Z.    O.    Tape. 


port  is  properly  adjusted  it  serves  as  a  passive  support  and  assists  in 
holding  the  foot  in  its  correct  position.  I  have  used  this  treatment 
for  nine  years,  and  clinical  cards  show  that  ninety  per  cent  of  the 


166 


THE    HUMAN    FOOT 


patients  have   obtained   permanent  relief  from   the  painful  condition 
treated. 

Massage,  forcible  correction  and  careful  judgment  in  fitting  the 
foot  to  modified  shoes  are  also  necessary.  The  sensitive  callouses 
may  be  removed  by  the  chiropodist's  method  or  with  pedico  callous 


Chart  Xo.  99 

X-Ray    Showing   Anterior   Metatarsal   Arch    Support   in    Position   to    Relieve 

Severe   Cramp  in  Third  and   Fourth   Toes. 

Xote    Plate    Cut    Away    Under    First    Metatarsal    Head. 

salve,  but  it  should  be  borne  in  mind  that  the  callouses  are  the  result 
of  the  constant  pressure  and  irritation  of  one  or  more  of  the 
Metatarso-Phalangeal  articulations,  in  which  a  positive  cure  can  only 
be  assured  by  supporting  the  arch  and  removing  the  friction  and 
pressure  with  the  Anterior  Metatarsal  arch  supports. 


MORTON'S    TOE  167 

A  Typical  Case. — To  show  the  necessity  of  mechanical  correc- 
tion, the  history  of  a  typical  case  is  here  given.  It  is  the  case  of  a 
young  lady  who  was  twenty  years  of  age  when  the  case  was  first 
brought  to  the  author's  attention. 

At  the  age  of  thirteen  she  became  aware  of  pains  in  her  feet  and 
limbs,  and  developed  extreme  nervousness.  Her  physician  said  she 
had  been  studying  too  hard  and  advised  a  rest  from  school.  Six 
months'  absence  failed  to  stop  the  nervous  irritation  or  the  cramps 
in  her  feet.  Internal  remedies  and  tonics  did  no  good.  A  New  York 
specialist  prescribed  gymnasium  exercises,  loose  clothing  and  a  dis- 
continuance of  her  studies. 

Finding  no  relief  she  consulted  an  orthopedic  surgeon  who  recom- 
mended specially  made  shoes,  which  gave  relief  when  first  worn, 
but  the  trouble  returned  and  she  was  advised  to  go  to  a  hospital. 
There  her  feet  were  placed  in  plaster  of  paris  casts  for  six  weeks, 
the  period  of  enforced  rest  bringing  temporary  relief.  Soon  there- 
after the  pains  and  nervous  condition  returned. 

Then  an  orthopedic  shoemaker  came  into  the  case  at  considerable 
expense  to  the  patient  for  shoes  and  service,  but  she  still  obtained 
no  relief. 

Some  time  after  this  the  case  was  brought  to  the  author's  atten- 
tion, without  any  of  the  particulars  being  given  him  at  that  time 
relative  to  former  treatments. 

The  trouble  was  soon  located,  the  young  lady  fitted  to  a  pair  of 
Anterior  Metatarsal  arch  supports  and  told  to  walk  around  for  half 
an  hour  to  test  the  fit.  Expressing  great  satisfaction  at  the  com- 
fort'and  relief  afforded,  she  admitted  it  was  the  first  time  in  years 
that  her  feet  had  really  felt  comfortable. 

A  week  later  she  reported  that  she  was  still  enjoying  perfect 
foot  comfort  and  entire  relief  from  nervousness,  together  with  great 
general  improvement  in  health. 

The  third  week  she  had  another  pair  fitted  and  was  advised  to 
purchase  shoes  that  would  fit  the  heel  and  waist  more  snugly  and 
allow  plenty  of  toe  room.  This  she  did  and  her  report  of  over  a 
month  later  expressed  the  greatest  satisfaction.  She  said  she  had 
no  pains  or  discomfort  whatever  and  her  health  was  excellent. 


CHAPTER    XXI 


METHOD  OF  FITTING  ARCH  SUPPORTS 

I  have  so  frequently  been  requested  by  students  and  by  prac- 
titioners to  give  them  an  outline  as  to  my  method  of  fitting'  corrective 
appliances,  that  I  believe  a  chapter  on  this  subject  will  be  of  great 
value  and  interest  to  the  reader.  It  is  very  important  to  recognize 
that  in  mechanical  appliances  we  have  an  armamentary  of  undis- 
puted value  in  the  treatment  of  foot  deformities,  but  the  success  of 
these  treatments  and  devices  depends  greatly  upon  their  application 


Chart  No.  100 
Arch    Fitter   and   Rawhide   Hammer   to   Take   Place  of 
Vise  and  Anvil. 


and  upon  the  intelligent  selection  and  fitting,  adjustment  and  advice 
to  the  patient  regarding  their  wearing. 

Using  the  words  of  a  prominent  orthopedic  surgeon,  "there  is 
also  associated  in  the  minds  of  the  laity  and  the  profession  that  the 
treatment  of  all  foot  troubles  is  the  question  of  arch  supports.  Few 
patients  complaining  of  their  feet  come  to  the  orthopedic  surgeon 
who  have  not  worn  at  least  one  of  the  variety  on  the  market  and, 

168 


FITTING   ARCH    SUPPORTS 


169 


PART  OF  ANVIL  FOR    CONFORMINO 
ANVIL 


MAKING  ADJUSTMENT 

ON  ANTERIOR  META 

TARSAL  ARCH 

SUPPORTS 


WOODEN  PRESSURE  BLOCK 

COVERED  WITH    LEATHER 

THAT     IS     PRESSED    INTO 

HIGH  PART  OF  ARCH 


ADJUSTING  LEVER   WHICH 

LOCKS       AUTOMATICALLY 

AND     HOLDS     ARCH      IN 

POSITION 


ADJUSTMENT  SCREW  FOR 

<^o£o  LARGER     0R     SMALLER 

SUPPORT  IS  PLACED  FO  R  SIZES  TO  ADJUST  PRES- 

ADJUSTMENT  SURE    OF    THE    BLOCK 

AGAINST  ARCH  SUPPORT 


Showing 


Chart  No.  101 
Mechanical    Parts   of   Patented   Arch   Fitter. 


Chart  No.  102 
Diagram  Showing  Correct  Length  of  Arch  Support  Leather  from 

Point   C   to    Line   of   Metatarso-Phalangeal    Articulation   A. 

Metal  Extends  Within  f£  inch  or  at  Line  B  so  as  not  to  Interfere 

with    Ball    Movement. 


170 


THE    HUMAN    FOOT 


although  the  practice  of  nnprofessionally  prescribing  arch  supports 
should  be  unreservedly  condemned,  I  should  not  be  surprised  if 
shoemakers  and  salesmen  of  these  articles  have  cured  as  many  pain- 


Chaet  No.  103 

Selecting   Correct   Length    Flush   with   Rounded   Fart   of  Heel   to 

Metatarso-Phalangeal    Joint. 


Chart  No.  104 
Diagram   Showing  Points  to  be   Fitted  with  Arch   Supports  to  Extend  from 

A  to  B. 

ful  feet  as  have  physicians/'  A  statement  of  this  kind  confirms  my 
belief  that  it  is  within  the  power  of  the  shoe-fitter  and  the  chiropodist 
to  do  much  toward  alleviating,  through  correctly  fitted  mechanical 
devices,  the  pains  and  annoyance  caused  by  foot  deformities,  but  it  is 


FITTING    ARCH    SUPPORTS 


171 


certainly  important  and  necessary  to  base  the  fitting  and  adjustment 
upon  physiological  and  anatomical  facts.  Experimentation  and  "try 
this"  or  "that"  method  should  not  be  resorted  to.  There  are  laws  of 
balance,  of  gravitation,  centralization  and  correction  in  this  work  that 
should  govern  us.  We  know  fully  too  well  how  closely  allied  are 
the  arteries,  bones,  nerves  and  important  tissues  of  the  foot  to  other 
parts  of  the  body,  and  in  the  fitting  of  appliances  these  structures 
must  be  given  consideration. 

I   take  it  for  granted  that  the  selection   of  the  arch  support   has 


Chart  No.  105 

Diagram    Showing    Shortly    Fitted    Arch    Support    Held    to    Foot. 

Leather  Part  Should  Fit  from  A  to  B,  while  Metal  Should 

Fit  to   C,   to    Span  Weight   Over   Shank  of   Shoe. 


been  made,  as  I  firmly  believe  that  properly  constructed  stock  arch 
supports,  when  there  is  choice  of  selection,  are  in  an  average  run  of 
cases  as  practical  and  adequate  as  making  supports  from  individual 
casts.  (I  refer  to  those  made  on  practical  and  scientific  lines.)  The 
supports,  however,  must  be  built  on  principles  that  are  orthopedically 
correct  and  must  be  constructed  of  material  which  will  permit  the 


172 


THE    HUMAN    FOOT 


necessary  adjustment  to  be  made.  Now  that  we  are  supplied  with 
the  arch  supports,  without  question  the  next  point  to  consider  is  a 
means  by  which  these  particular  adjustments  can  be  made.  I  use 
a  patented  arch  fitter  and  a  steel  rawhide  faced  hammer  for  the 
purpose  of  adjustments  and  fittings.  (See  Chart  No.  100.)  This  arch 
fitter  is  constructed  of  malleable  iron  and  steel  to  act  as  an  automatic 
vise,  having  a  steel  conforming  anvil  and  wooden  pressure  block  and 


\  Y 


/ 


Chart  No.  106 

Showing    Foot-Fazer    Fitted    too    Long.      Correct    Length    is    from 

Point  A   to   B   for   Leather,   while   Metal 

Should   Come   to   Point   C. 


adjustment  screw,  with  a  lever  for  manipulating.  (See  Chart  No.  101.) 
It  affords  a  quick  and  accurate  means  of  making  adjustments  without 
resorting  to  the  blacksmith  shop  anvil  method.  (See  Chart  No.  114.) 
Although  the  beating  out,  or  hammering  to  shape,  plates  of  German 
silver,  soft  steel,  brass,  copper,  etc.,  has  been  the  old-time  method  of 
the  bracemaker,  I  believe  that  to  be  efficient  the  orthopedist  should 
be  qualified  to  gauge  his  adjustment  according  to  the  condition  of 
the  case  being  treated.    There  are  no  two  feet  exactly  alike,  and  it  is 


FITTING    ARCH    SUPPORTS 


173 


not  at  all  uncommon  to  find  it  necessary  to  make  adjustment  for  one 
foot  entirely  different  from  that  for  another.  This  is  very  nicely 
handled  with  the  use  of  this  arch  fitter.  Selecting  the  right  size  and 
the  correct  length  of  the  arch  supports  is  of  the  utmost  importance. 
Those  varieties  that  are  covered  with  leather  for  additional  protection 
to  the  foot  should  be  selected  to  extend  from  the  point  flush  with  the 
rounded  part  of  the  heel  so  the  thinly  skived  point  of  the  leather 
reaches  the  first  Metatarso-Phalangeal  joint.     (See  Chart  No.  103.) 


Chart  No.   107 

Dotted  Lines   Indicate   Where   Most   Pressure   Should 

Le   Given   in    Fitting    Supports   for 

x\rch   Trouble. 


In  the  construction  of  my  appliances  I  always  allow  three-eighths 
of  an  inch  from  the  forward  edge  of  the  metal  to  the  extreme  edge 
of  the  thin  part  of  the  leather  covering.  In  that  way  I  may  gauge 
my  correct  fitting  by  the  lengths  of  the  leather,  as  noted  in  diagram. 
(See  Chart  No.  103.)  This  shows  the  flush  fitting  at  the  heel  and  the 
articular  point  to  avoid  at  the  Metatarsal  arch.    I  show  in  my  diagram 


174 


THE    HUMAN    FOOT 


the  stockinged  foot,  as  it  is  more  convenient  and  more  practical  as  a 
rule  to  fit  over  the  stocking.  The  arch  support  or  foot-eazer  should 
then  fit  in  length  from  the  heel  part  forward  to  the  first  Metatarso- 
phalangeal joint  or  at  the  ball  of  the  foot  where  the  foot  bends. 

In  the  selection  of  the  size  of  the  arch  support  to  be  fitted  to  the 
weak  flexible  foot,  where  considerable  elevation  and  adjustment  is 
to  be  made,  a  longer  size  must  be  selected  to  allow  for  the  shortening 
or  drawing  up  of  the  appliance  in  the  process  of  elevation.  Care  must 
be  taken  to  obtain  the  correct  length,  as  a  shortly  fitted  appliance 


Chart  No.  108 

Care  to  See  That  Leather  Extends  Flush  Under  Heel 

Above     Shows    Fiat-Foot    Properly    Fitted    so    That    Support    Touches    All 

Points    Evenly. 


rests  upon  the  shank  of  the  shoe,  which  is  insufficient  to  bear  the 
weight,  and  in  a  very  short  time  breaks  down,  creating  a  very  poor 
appearance  of  the  outlines  of  the  shoe.  Selecting  the  proper  width 
is  also  very  important.  I  find  it  necessary  to  construct  the  supports 
in  two  widths,  wide  and  narrow,  and  this  applies  to  the  metal  springs 
as  well  as  the  leather.  Wide,  short  or  fleshy  feet  should  be  fitted 
wide  so  that  a  substantial  bearing  point  for  the  Plantar  surface  may 
be  had,  yet  not  so  that  the  support  will  distort  the  shoe. 

If   an   all-metal   plate   or   surgical    insole   be   fitted   it   must   then 


FITTING    ARCH    SUPPORTS 


17= 


.be  fitted  three-eighths  of  an  inch  behind  the  Metatarsophalangeal 
joints.  There  are  variations  to  consider,  especially  where  there  is 
undue  prominence  of  the  Metatarsal  head,  from  which  pressure  should 
be  avoided.  Now,  with  the  arch  fitter  securely  fastened  so  that  it 
may  be  manipulated  without  shifting,  you  are  now  ready  for  adjust- 
ment. First  select  the  size  of  support;  then,  placing  the  support 
against  the  Plantar  surface  of  the  foot,  notice  whether  it  touches  all 


Chart  No.  109 

Showing   Correct    Length    of   Anterior    Metatarsal   Arch    Support. 

Leather  to  Fit  to  Dotted  Line. 


points  of  the  Longitudinal  arch  evenly.  The  patient's  foot  is  to  be 
relaxed  and  the  fitting  done  with  the  foot  in  a  position  of  rest.  If 
not,  the  necessary  adjustments  must  be  made.  When  the  support  is 
properly  fitted  it  will  touch  all  points  of  the  arch  smoothly  and  evenly, 
holding  the  foot  in  its  correct  position.  Several  adjustments  and 
operations  may  be  necessary  on  the  support  before  it  will  absolutely 
fit  the   condition.      When   the    fitting  is    made   properly   there    is    an 


176 


THE    HUMAN    FOOT 


evenly  distributed,  well  directed  pressure  at  all  points  which  insures 
comfort  and  relief  at  once.  Care  must  be  taken  that  there  is  sufficient 
length  of  leather  or  a  bit  of  metal  plate  immediately  under  the  heel, 
so  that  there  is  a  pad  for  the  heel  to  rest  upon.  (See  Chart  No.  108.) 
If  the  arch  is  considerably  displaced  and  flattened,  so  that  the  arch 
support  appears  too  high,  it  is  then  best  to  commence  the  fitting  by 
first  lowering  the  support.  To  do  this  place  the  support  on  the  con- 
forming anvil,  metal  part  down,  and  with  the  rawhide  faced  hammer 


"  '■"' 

^\C 

'     -• "' 

!  1  / 

Chart  No.   110 
Placed  to  Plantar   Surface  to  See  What  Adjustments  are  to  be  Made. 


tap  the  top  side  of  the  leather  support  gently  but  firmly,  then  apply 
to  the  Plantar  surface  of  the  arch  and  notice  where  the  elevations 
are  to  be  made.  Then  place  the  support  between  the  conforming 
anvil  and  pressure  block,  drawing  the  leather  toward  you,  and  tapping 
that  part  of  the  support  to  be  raised  with  the  rawhide  faced  hammer. 
(See  Chart  No.  114.) 

It  must  be  borne  in  mind  that  rigid  flat-foot  cannot  withstand  the 
same  amount  of  pressure  as  the  flexible  flat-foot,  or  the  weakened 
flexible  foot,  either  of  which  may  withstand  a  erreater  amount  of  cor- 


FITTING    ARCH    SUPPORTS 


177 


rection  or  pressure  from  the  supports.  To  obtain  adjustments  to  these 
conditions  the  same  rule  should  apply  in  selecting  the  length  and  ele- 
vating the  support  so  as  to  touch  all  points  of  the  Plantar  arch  evenly 
and  smoothly,  but  not  severely. 


Chart  No.  Ill 
Elongating  Heel  so  as  to  Make  a  Heel  Bed  for  the  Depressed  Os  Calcis  or 
Elongated  Heel. 


In  those  cases  where  the  posterior  region  of  the  Longitudinal  arch 
may  be  affected,  the  Os  Calcis  is  forced  down  and  backward,  making 
a  long  heel,  and  more  flattened  surface  under  the  heel.  For  this  con- 
dition the  heel  part  of  the  arch  support  should  be  elongated,  giving  a 

12 


178 


THE    HUMAN    FOOT 


longer  surface  for  the  heel  to  rest  upon.  This  is  done  by  placing  the 
support  between  the  conforming  anvil  and  pressure  block  (see  Chart 
No.  Ill),  having  the  heel  part  drawn  out  away  from  the  machine  until 
the  distance  between  the  end  of  the  heel  part  of  support  and  extreme 
edge  of  the  conforming  anvil  is  the  distance  where  elongation  adjust- 
ment is  required.  Then  gently  tap  the  metal  part  at  the  heel, 
straightening  it  as  shown  in  Chart  No.  113.  Then  again  fit  to  the 
patient's  foot,  noting  what  further  changes  are  needed,  and  readjust 


Chart  No.   112 
Showing  Foot-Fazer  Adjusted  to  Fit  Long  Heel.     Note  Heel  Bed  A  to  B. 


so  that  the  entire  support  fits  all  points  of  the  foot.  The  manipulation 
of  this  particular  adjustment  for  elongated  heel  is  very  important,  for 
if  it  is  not  properly  done  the  support  is  apt  to  slide  forward  so  that  the 
heel  of  the  foot  is  not  protected  all  over  by  the  leather  covered  base. 
After  the  foot  is  properly  fitted  with  the  arch  support  then  place  in  the 
patient's  shoe  and  learn  if  the  support  sits  firmly  in  the  heel  seat,  and 
at  the  point  forward  of  the  shank,  and  fits  so  that  no  weight  or  strength 
is  thrown  upon  or  required  of  the  shank  part  of  the  shoe.     (See  Chart 


FITTING   ARCH    SUPPORTS 


179 


No.  116.)  It  is  very  important  to  be  sure  that  there  is  no  rocking  or 
tilting  of  the  support  inside  the  shoe,  and  that  it  sits  firmly  in  the  heel 
seat  and  forward  part  of  the  shank.  Arch  supports,  when  fitted  to  the 
foot,  should  then  be  fitted  to  that  particular  type  of  shoe.  The  poise 
of  the  foot  is  changed  in  various  extreme  styles  of  footwear.  High 
heels  and  low  heels  considerably  alter  the  poise  and  balance  of  the 


Chart  No.  113 

After  Heel  is  Elongated  as  No.  Ill,  Support  is  Placed  on  Rounded  Part  of  Conforming 

Anvil  to   Straighten  Any  Uneven   Points. 


foot,  and  the  support  should  first  be  fitted  to  the  foot  and  then  placed 
in  the  shoe  to  make  sure  that  it  fits  at  both  points,  heel  seat  and  for- 
ward of  shank,  and  if  so  there  should  be  no  slipping  or  forcing  the  heel 
out  of  the  shoe.     (See  Chart  No.  117.) 

The  rule,  as  I  have  given  you  above,  applies  to  the  fitting  of  the 
Anterior  or  Transverse  arch.     The  metal  part  of  the  support  should 


180 


THE    HUMAN    FOOT 


always  remain  about  three-eighths  of  an  inch  from  the  Metatarsal 
articulations,  and  the  style  of  Metatarsal  arch  support  for  Metatar- 
salgia  and  Morton's  toe  must  be  governed  by  the  age  of  the  patient, 
condition  of  foot  and  severity  of  the  case.     When  there  is  pressure 


Chart  No.  114 

Elevating    Arch    Support.      Note    Line    on    Which    the 

Rawhide   Hammer   is  to   be  Used. 


upon  the  third  or  fourth  Metatarsal  head,  which  is  indicated  by  cal- 
losity and  tenderness,  the  elevation  to  the  anterior  part  should  be  made 
in  a  dome-like  shape  from  the  first  to  the  fifth  Metatarsal,  but  most 
exaggerated  just  beneath  and  behind  the  dropped  Metatarsal. 


FITTING    ARCH    SUPPORTS 


181 


In  severe  cases  of  Morton's  toe  and  Metatarsal  pains  the  elevation 
may  be  placed  between  the  third  and  fourth  Metatarsal  heads.  Some- 
times it  is  necessary  to  make  these  elevations  the  size  and  shape  of 
a  large  olive,  and  again  only  a  slight  oval  shape  is  necessary. 

These  elevations  and  fittings  are  very  easily  accomplished  by  my 
method,  and  the  use  of  the  arch  fitter,  as  the  conforming  anvil  has  an 


Chart  No.  115 

Dotted  Lines  Indicate  Where  Most  Pressure  is   Required 

for  Metatarsalgia. 


oval  depression  in  which  the  metal  may  be  hammered  to  shape.  The 
following  schedule  may  be  used  as  a  guide  in  determining  the  adjust- 
ment : 

Weak  Flexible  Foot — Relaxed  Foot. — Use  light  spring  support 
snugly  fitted,  most  elevation  directly  beneath  Inner  Malleolus. 

Moderate  Fiat-Foot,  where  structural  change  has  taken  place,  re- 


182  THE    HUMAN    FOOT 

quires  support  fitted  evenly,  but  not  extremely  high.  Adjust  when  the 
weight  is  off  the  foot. 

Extreme  Fiat-Foot  With  Swelling. — Fit  all  points  of  arch  when  the 
weight  is  off  the  foot.     Make  adjustment  low. 

Rigid  Fiat-Foot  With  Adhesions. — Fit  arch  support  extremely  low, 
taking  care  to  prevent  skin  or  local  irritation  from  pressure  at  any  near 
point  of  the  flange  of  the  arch  support. 

Weak  Arch  With  Enlargement  at  First  Metatarso-Phalangeal 
Joint. — Fit  arch  supports  to  all  points  of  Longitudinal  arch  snugly, 


Chakt  No.  116 

Shows  Support  After  Adjustment  and  It  is  at  Once  Obvious  That 

Room   has   Been   Given   for   the   Heel  to   Sink   Before 

Actual  Arching  of  the   Support  Takes  Place. 


then  give  added  elevation  to  furnish  added  support  just  behind  en- 
larged joint  to  remove  dead  weight  and  pressure.  Light,  springy 
support  is  indicated. 

Weak  Ankles  and  Inward  Rotation. — Fit  supports  to  permit  sup- 
port and  pressure  directly  beneath  ankle  joint  to  hold  it  firmly  in 
position. 

Extreme  High  and  Contracted  Arch. — Fit  arch  support  high  in 
center  allowing  space  of  approximately  one-eighth  inch  between 
highest  point  of  arch  and  highest  point  of  arch  support.     Support 


FITTING   ARCH    SUPPORTS 


183 


Chart  No.  117 
After    Support   is    Fitted   to    Foot,    Place 
Shoe   to   Test   Fit   in   Heel   Seat  to 
Prevent   Slipping. 


Chart  No.  118 

X-Ray  of  Woman's  Foot,  Fitted  to  Arch  Support  which  Also  Shows  Bearing 

Points  of  the   Support   Inside   the    Shoe. 


184 


THE    HUMAN    FOOT 


should  be  fitted  a  trifle  longer  than  ordinarily,  to  give  slight  super- 
expansion  forward. 

Metatarsalgia  and  Morton's  Toe,  Cramped  Toes  and  Displaced 
Metatarsal. — Use  Anterior  Metatarsal  arch  support.  Fit  contour  of 
Longitudinal  arch,  make  transverse  elevation  just  behind  location  of 
severe  cramps  and  depressed  Metatarsal. 


Chart  No.  119 

Crosses     Point    Heads    of    Metatarsals    at 

Transverse    Arch    and    Cross    at    Heel 

Points     Tuberosity     of     Os     Calcis. 

Support    Should    not    be    Fitted 

Beyond  the  Forward  Points. 


Callouses  On  Ball  of  Foot. — Fit  light,  springy  support  and  adjust 
evenly  to  Plantar  surface  of  arch,  with  added  slight  elevation  at  for- 
ward end. 

For  Painful  Heel  and  for  Bursitis,  Spur  of  the  Os  Calcis,  Etc. — 
Fit  arch  supports  high  at  weight  carrying  points  beneath  Scaphoid 


FITTING   ARCH    SUPPORTS 


185 


and  Astragalus,  adjusting  so  that  the  metal  of  the  support  remains 
one-quarter  inch  from  heel  of  foot  when  the  support  fits  all  other 
points  of  the  arch  by  removing  all  pressure  possible  from  the  Os  Calcis. 

For  Weak  Foot  With  a  Tendency  of  Rolling  Outward,  a  thin 
wedgelike  piece  of  sole  leather  may  be  inserted  between  the  leather 
and  metal  part  of  the  support,  to  prevent  the  foot  from  sliding  off  after 
regular  usual  adjustment  has  been  made. 

For  Foot  Strain,  causing  bodily  fatigue,  use  lightweight  foot- 
eazer.     Adjust  to  fit   contour  of  foot,  to  relieve  ligamentous   strain. 


Chart  No.  120 
Method  of  Lowering  Arch  Support  to  Any  Given  Point. 

Cramped  Toes. — Fit  lightweight  foot-eazer  to  hold  arch  in  posi- 
tion, to  equalize  weight  and  to  prevent  foot  from  slipping  forward  into 
toe  of  shoe. 

Children's  Weak  Ankles. — Where  weakness  is  in  ankle  articu- 
lation, fit  lightweight  support,  forcibly  correcting  condition  by  well 
elevating  support. 

HOW  TO   MAKE  SECONDARY   ADJUSTMENT 

Since  the  patient  has  been  properly  fitted,  and  the  foot  restored  to 
a  degree  of  usefulness  and  comfort,  progressive  elevation  and  correc- 
tion can  be  accomplished  by  having  the  patient  return  in  two  or  three 


186 


THE    HUMAN    FOOT 


weeks  for  a  further  and  final  adjustment.  In  that  way  the  minor 
details  of  adjusting  can  be  carefully  followed  up,  and  if  there  is  any 
slight  local  irritation  the  pressure  may  be  removed  from  the  foot  in 
one  place  and  added  pressure  restored  to  another,  so  that  a  permanent 
cure  may  be  effected  within  a  reasonable  time.  # 

CRYSTALLIZATION  OF  METALS  FROM  WHICH  ARCH 
SUPPORTS  ARE  MADE 

One  of  the  difficulties  encountered  in  the  construction  of  ortho- 
pedic appliances,  and  particularly  arch  supports  and  those  appliances 


Chart  No.  121 

Showing  How  Elevation  to  Anterior  Arch  is  Made  by  Placing  Over  Oval  Opening, 

in   Conforming  Anvil  and   Using   Rawhide   Hammer. 


worn  inside  the  shoe,  has  been  to  secure  a  durable,  rust-resisting,  light- 
weight metal.  Steel  is  unexcelled  for  lightness  and  strength  when 
made  of  a  fine  gauge  and  highly  tempered,  but  will  not  admit  of  ad- 
justment. Brass  is  subject  to  deterioration,  and  is  very  difficult  to 
work  up.     German  silver  is  most  easily  worked  and  fashioned  into 


FITTING -ARCH    SUPPORTS  187 

shape,  but  is  quite  heavy,  and  is  subject  to  crystallization.  Other 
metals  are  bronze,  silveroid,  durabellum,  magni  bronze  and  hyolite 
bronze  and  aluminum.  Nearly  all  these  metals  are  subject  to  laws  of 
crystallization,  and  in  time  will  so  harden  from  the  constant  springing 
and  strain  of  carrying  of  one's  weight  that  they  will  crack  and  break, 
and  it  is  advisable  to  explain  this  to  the  patient,  as  many  shoe  dealers, 
chiropodists  and  physicians  are  of  the  opinion  that  these  supports  are 
indestructible. 


CHAPTER    XXII 


HALLUX   VALGUS   AND   BUNION 

Hallux  valgus  is  a  term  applied  to  a  partial  displacement  or  out- 
ward dislocation  of  the  great  toe  at  the  Metatarso-Phalangeal  joint. 
The  srreat  toe  is  forced  outward,  sometimes  under  and  at  other  times 


Chart  No.  122 
X-Ray   Showing  Bone  Displacement   in   Hallux  Valgus. 

overlapping  the  other  toes.  In  its  displaced  position  the  cartilaginous 
surface  of  the  head  of  the  Metatarsal  becomes  inflamed,  which  later 
involves  the  soft  tissue. 


HALLUX    VALGUS    AND    BUNION  189 

This  frequently  leads  to  confusion  as  hallux  valgus  condition, 
which  is  accompanied  by  enlargement  at  the  great  toe  joint,  seems 
to  be  regarded  by  the  public  as  a  bunion,  when  as  a  matter  of  fact 


Chaet  No.  123 
Bunion   with   Hallux   Valgus. 


hallux  valgus,  strictly  speaking,  consists  of  the  deformity  of  the  bone 
which  in  severe  cases  does  cause  an  enlargement  at  the  Metatarso- 
phalangeal joint. 

Bunion  is  most  generally  associated  with  hallux  valgus.     Using 


190 


THE    HUMAN    FOOT 


the  public  phraseology  and  definition,  a  bunion  is  any  enlargement  at 
the  first  Metatarso-Phalangeal  joint.  A  bunion  consists  of  an  inflam- 
mation of  the  soft  tissues  over  the  great  toe  joint,  generally  produc- 
ing a  bursa.  This  part  is  swollen,  tender  and  red,  and  may  even  sup- 
purate, the  abscess  often  involving  the  joint. 

In  the  treatment  of  foot  deformities  there  is  probably  no  malforma- 
tion or  deformity  so  easily  recognized  externally  as  hallux  valgus. 


Chart  No.  124 
Bunions   of   Long   Standing  Accompanied   with   Flat   Foot. 


There  are  various  causes,  but  the  most  marked  are  mechanical  causes, 
and  under  this  head  the  wearing  of  short,  pointed  toe,  narrow,  re- 
stricted shapes  are  the  most  frequent  causes,  for  when  pressure  is 
brought  to  bear  upon  the  foot  full  expansion  is  not  permitted  and  the 
great  toe  is  forced  backward  and  outward.  Hosiery  worn  short  and 
pointed   at   the   toe   is   another   frequent   cause.      Rheumatism,   gout, 


HALLUX    VALGUS    AND    BUNION  191 

rheumatoid  arthritis,  osseo-arthritis  also  produce  a  defect.  Weak  arch 
and  flat-foot  condition  can  be  traced  in  a  great  number  of  cases  as 
being  the  direct  cause.  The  deformity  is  one  slowly  produced,  over 
a  considerable  period  of  time,  and  with  the  first  toe  is  being  gradually 
displaced.  The  pain  is  not  greatly  felt  until  a  new  irritation,  caused 
by  pressure,  brings  it  to  the  sufferer's  attention.    It  is  not  unusual  to 


Chart  No.  125 
X-Ray  of  Bunion  Foot  After  Hallux  Valgus  Opera- 
tion    Showing     Head     of     First     Metatarsal 
Excised    and     Second    Toe    Removed 
Owing  to  Underlapped  Position. 


find  the  Phalanges  in  the  second  toe  distorted  through  crowding  up- 
ward of  the  great  toe,  sometimes  under  and  sometimes  over.  Corns 
and  callosities  very  frequently  form  which  become  very  painful.  If 
the  hallux  valgus  foot  is  examined  with  the  X-ray  it  will  be  found 
that  the  first  Phalanx  is  more  or  less  displaced,  as  also  the  outer  sur- 
face of  the  head  of  the  first  Metatarsal  bone.     It  will  be  found  in  a 


192 


THE    HUMAN    FOOT 


position  of  subluxation,  or  partial  dislocation.  The  Internal  Lateral 
ligament  is  elongated  and  often  thickened,  and  the  External  Lateral 
ligament  is  shortened.  Sometimes  the  inflammation  at  the  point  of  the 
deformity  may  cause  suppuration,  and  an  abscess  may  open  externally 
or  into  the  joint,  or  into  both  directions,  but  this  is  only  found  in  the 
most  severe  and  rare  cases.  In  the  acquired  cases  the  toe  can  easily  be 
placed  to  a  straight  line  with  the  foot  by  taking  hold  of  the  Distal 
Phalanx  and  stretching  the  toe  inward,  but  in  the  more  severe  cases 


Chart  No.  126 

Bunion  with  Overlapping 

Second  Toe. 


and  cases  of  long  standing  this  is  more  difficult.  There  are  found  per- 
sons with  hallux  valgus  which  may  be  traced  to  hereditary  causes. 
These,  as  a  rule,  are  not  as  painful  and  distressing,  except  by  the 
annoyance  of  being  improperly  fitted  with  footwear.  The  deformity 
is  more  common  in  women  than  in  men,  probably  due  to  the  fact 
that  the  shoes  worn  by  women  are  of  a  more  pointed  toe  shape. 

Treatment. — The  treatment  indicated  in  hallux  valgus  and  bunion 
is  usually  mechanical.     The  first  essential  is  to  remove  the  cause.     If 


HALLUX  VALGUS  AND  BUNION 


193 


short  stockings,  short  shoes  or  pointed  toe  shoes  have 'been  worn 
replace  with  the  correct  styles  and  sizes.  Then  the  object  is  to 
straighten  the  deformed  toe  to  a  straight  line  of  the  foot.  This,  in 
milder  cases,  may  be  effected  by  use  of  a  spool  toe  post,  known  as  a 
bunion-right,  or  toe  flex.  These  devices  are  made  of  rubber  and  have 
a  top  and  bottom  shield  so  as  to  exert  a  continuous  pressure  to  hold 
the  displaced  member  to  its  normal  position.  These  devices  are  espe- 
cially essential  in  the  early  stages  and  in  those  cases  that  are  not 
flexible  and  subject  to  traction.     If  these  devices  are  worn  during 


Chart  No.  127 
Note   Flexibility   of    Same    Foot. 


the  day  in  a  shoe  that  will  permit  the  straightening  of  the  toe,  con- 
siderable relief  can  be  secured.  For  night  wear  a  bunion  spring  is 
indicated.  By  far  the  most  practical  that  has  yet  been  placed  upon 
the  market  for  the  use  of  the  orthopedic  operator  consists  of  a  spring 
made  of  metal,  having  an  oval  opening  over  the  enlarged  joint,  padded 
with  soft  felt  to  relieve  it  from  pressure,  and  with  a  means  of  holding 
to  the  foot  so  as  to  act  as  a  lever  in  drawing  the  displaced  toe  to  a 

13 


194 


THE    HUMAN    FOOT 


straight  line  of  the  foot.  The  author's  bunion  spring,  such  as  described 
above,  has  an  added  spring  which  is  attached  to  the  lever  with  a  pivot 
extending  under  the  ball  of  the  foot,  which  prevents  displacement 
either  in  the  shoe  or,  if  worn  at  night,  by  the  bed  clothing.  This 
Metatarsal  spring  by  its  support  offers  a  means  of  raising  the  Met- 
atarsal arch  which  relaxes  the  Internal  Lateral  ligaments.  It  can  be 
adjusted   by  lacing,  whereb}T  gradual  correction  can  be  had.     The 


W  I     I 


Chart  No.  128 

Toe  Flex   Placed  in   Position 

Bringing    Toe    to     Normal 

Position    and    Correcting 

Overlapping   Second 

Toe. 


spring,  as  described  above  and  illustrated  in  Charts  Xos.  129  and  130, 
can  be  worn  in  a  large  shoe  for  day  wear,  but  is  most  practical  for 
night  wear.  Where  there  is  considerable  tenderness  and  external 
pressure  produced  by  the  shoe,  a  shield  made  of  gutta  percha  or  rubber 
molded  to  conform  to  the  actual  lines  of  the  foot,  having  a  shoulder 
at  the  posterior  part  of  the  Metatarsus  slightly  concaved  at  the 
forward  inner  edsre  so  as  to  allow  room  for  the  srreat  toe  to  assume 


HALLUX  VALGUS  AND  BUNION 


195 


its  normal  position,  is  most  efficacious  in  relieving  pain  and  pres- 
sure. Where  there  is  considerable  superfluous  tissue  or  enlargement,  or 
local  inflammation,  or  tenderness,  this  shield,  known  as  bunion  re- 
ducer, as  named  by  me,  will  create  a  mild  hyperemia,  stimulating  cir- 
culation and  reducing  the  enlargement.  The  bunion  reducer  is  worn 
directly  over  the  affected  joint  and  when  fitted  properly  in  that  way 
will  not  shift  out  of  position.  The  advantages  also  in  this  reducer  are 
in  the  relieving  of  shoe  pressure  and  also  to  maintain  the  original  shape 
of  the  shoe  so  as  to  hide  the  deformity.     These  rubber  reducers  are 


Chart  No.   129 
Bunion  Spring  Applied. 


made  in  stock  sizes  to  fit  all  ordinary  cases  and  can  be  vulcanized  from 
casts  of  the  enlarged  joint  in  more  severe  or  peculiarly  shaped  con- 
ditions. 

In  all  instances  where  the  Longitudinal  arch  is  weakened,  or 
where  the  dead  weight  of  the  body  is  thrown  upon  the  first  Metatarso- 
phalangeal joint,  due  to  weakness  or  constant  use  of  the  feet,  an 
arch  support  should  be  fitted  to  the  foot.  The  springy  support  of 
two  pieces,  allowing  free  movement  anteriorally,  should  be  used,  and 
in  the  adjustment  it  is  advantageous  to  posterially  lift  the  enlarged 


196 


THE    HUMAN    FOOT 


joint.  It  should  be  borne  in  mind  by  the  practitioner  that  relief  is 
the  essential  thing  to  consider,  and  frequently  the  foot-eazer,  fitted 
to  support  the  arch,  will  give  immediate  relief.     Toe-free  hosiery  is 


1 

V 

Chart  No.  130 

Top  View  of  Bunion   Spring 

in  Position. 


also  indicated.     In  the  more  severe  cases  surgical  operation  must  be 
resorted  to  if  correction  of  the  deformity  is  desired. 


Chart  No.   131 
Rubber    Bunion   Reducer   Applied   to    Foot. 


HALLUX    VALGUS    AND    BUNION  197 

FELT    PADDING 

Concaved  pads  of  felt,  smoothly  skived,  that  can  be  placed  about 
the  affected  area  to  remove  pressure,  are  very  useful  and  frequently 
used  by  those  who  have  the  deformity  of  long  standing,  as  well  as 
the  hereditary  cases,  and  where  there  appears  to  be  but  little  mobility 
in   the  joint.     The  object  of  the  pad  is   to  relieve  pressure  of  the 


L,.C3  ■,(.■;.-; 

^<^^:;'.''v'v,-"::-;'S-:.: 


Chart  No.  132 
Skived  Kiro  Pad  for  Bunion  Joint. 


shoe.  Kiro  pads  are  most  useful  for  the  practitioner,  inasmuch  as 
they  are  automatically  skived  by  patented  process,  leaving  the  inner 
surface  concave  to  fit  the  foot  externally  and  shaped  so  as  to  admit 
the  wearing  of  the  usual  shoe.  Another  means  which  I  have  used 
very  successfully,  and  which  is  desirable  in  the  extremely  prominent 


Chart  No.  133 
Skived    Concave    Kiro    Pad. 


joint  where  bunion  growth  is  apparent,  is  the  method  of  padding  the 
inside  of  the  shoe  with  specially  shaped  pads  known  as  Strait-Shu 
Bunion  Pads.  Two  pads  are  necessary,  one  behind  the  bunion,  which 
is  longer  and  thicker,  although  concave,  and  the  forward  one,  which 
is  shorter  and  thinner  and  convex.     They  are  applied  by  a  suitable 


198 


THE    HUMAN    FOOT 


Chart  No.  134 
Kiro   Pad  with   Thick   Shoulder  and   Center   Opening. 


Chart  No.   133 
Kiro    Pad   with    Shoulder    Behind,    Enlarged   Joint. 


HALLUX  VALGUS  AND  BUNION 


199 


adhesive  which  must  be  moisture-proof  and  are  placed  in  position  in 
the  inside  lining  of  the  shoe  so  that  the  enlarged  joint  positions 
itself  between  the  two   pads.     This   method  has  been   so   successful 


Chart  No.  136 
Kiro    Pad    Applied    Over    Bunion   Joint. 


that  many  patients  have  their  shoe  dealer  affix  the  pads  to  each  pair 
of  new  shoes. 

Medical    treatment   consists   of   applying  Wenal,    which    can   be 
followed  by  cold  applications;  wet  dressings,  hot  boric  poultices,  oint- 


Chart  No.  137 

Strait-Shu    Bunion    Pads    Attached   to    Inner 

Lining   of    Shoe. 


ment,  etc.,  are  frequently  used  with  a  purpose  of  alleviating  the  pain. 
Felt  rings  or  washers,  plasters,  etc.,  should  be  avoided  as  they  only 
tend  'to  aggravate  the  condition. 


200  THE    HUMAN    FOOT 

TREATMENT    OF    BUNION 

Bunion  is  so  frequently  associated  with  hallux  valgus,  as  previously- 
stated,  that  it  becomes  necessary  to  describe  treatment  for  this  in- 
flammatory condition  in  conjunction  with  the  foregoing.  Remove 
pressure  of  the  shoe  and,  if  very  badly  inflamed,  give  absolute  rest 


Chart  No.  138 
Bandaging  After  Kiro   Pad  Has  Been  Applied. 


to  the  foot  by  elevating  same  after  a  warm  foot  bath.  Then  apply 
Wenal  ointment  to  the  parts.  The  following  day  soft  felt  Kiro  pads 
are  applied  until  all  inflammation  desists.  Should  there  be  any  sup- 
puration or  abscess,  same  should  be  treated  surgically. 


CHAPTER  XXIII 


HALLUX   RIGIDUS   OR   PAINFUL   GREAT   TOE— 
HALLUX  VARUS  OR  PIGEON  TOE 


HALLUX   RIGIDUS   OR  PAINFUL   GREAT  TOE 

Painful  Great  Toe  is  also  known  as  flexus,  hallux  rigidus  and 
hallux  dolorosus.  This  condition  of  painful  great  toe  is  attended 
with  great  pain  in  the  first  Metatarso-Phalangeal  joint,  and  consists 
of  ankylosis  of  the  Metatarso-Phalangeal  joint  of  the  great  toe.  When 
the  toe  is  moved  external  inflammation  appears.  There  is  but  slight 
rigidity,  but  considerable  pain  and  occasionally  slight  swelling.     This 


Chart  No.  139 
Painful  Great  Toe  with  Weakened  Arch. 

is  invariably  caused  by  a  condition  of  flat-foot,  incipient  flat-foot,  or 
with  shoes  that  are  fitted  too  short,  but  is  sometimes  caused  by  an 
injury  to  these  parts.  A  weakened  foot  elongates  and  slides  forward 
into  the  toe  of  the  shoe,  which  doesn't  permit  the  foot  to  stretch  out 
to  its  entire  length,  creating  an  inflammation  at  the  Metatarso-Pha- 
langeal joint.     This  condition  is  most  frequently  found   in  growing 

201 


202  THE    HUMAN    FOOT 

boys  and  girls  and  it  can  be  detected  by  movement  of  the  great  toe 
and  by  careful  examination  for  weak  flat-foot. 

Treatment. — Fit  the  Longitudinal  arch  to  an  arch  support  or  foot- 
eazer,  so  that  the  Longitudinal  arch  will  have  an  even  bearing  at  all 
points,  the  object  being  to  remove  the  pressure  on  the  painful  joint 
and  to  restore  the  natural  motion  of  the  foot,  removing  muscular  and 
ligamentous  strain,  also  the  pressure  of  the  body's,  weight  at  the 
affected  joint.  These  conditions  should  be  handled  in  the  same 
manner  as  weak  foot  or  incipient  flat-foot.  Care  must  be  taken  that 
the  shoe  is  of  sufficient  length  and  no  restricting  action  produced  by 
the  stocking. 

Where  considerable  pain  is  present,  a  stiffening  device  should 
be  inserted  between  the  soles  of  the  shoes. 

HALLUX  VARUS  OR  PIGEON  TOE 

Hallux  Varus  is  also  known  as  pigeon  toe.  It  is  of  little  impor- 
tance and  usually  congenital  in  origin.     Occasionally  it  may  be  seen 


Chart  No.   140 
Showing   Method    of   Wedge    feather    Application   to   the    Sole    for    Pigeon   Toe. 

in   children   with    flat-foot,   also   in   cases  of   overcorrected   club-foot, 
usually  resulting  in  valgus. 

It  consists  of  a  toeing  in  or  abnormal  adduction  of  the  great  toe. 


HALLUX  VARUS  203 

While  in  pigeon  toe  an  adduction  of  all  the  toes  is  present,  it  is 
mostly  congenital  and  in  the  latter  it  is  generally  due  to  a  rotation 
of  the  entire  limb  while  in  the  former  the  great  toe  seems  to  be  re- 
laxed, allowing  it  to  adduct.  At  times  it  has  been  found  in  connection 
with  severe  cases  of  knock-knee. 

Treatment. — While  bandaging  in  the  opposite  direction  of  the 
deformity  can  be  used  with  considerable  aid  in  the  early  stage,  from 
my  observation  I  find  that  by  adding  to  the  outsole  of  the  shoe  a 
triangular-shaped  piece  of  sole  leather  on  the  inner  side  from  a  line 
drawn  at  the  center  of  the  sole  of  the  shoe  to  just  behind  the  ball 
definite  results  will  be  obtained.      (See  Chart  No.   140.) 


CHAPTER  XXIV 


PAINFUL  HEEL 

As  a  rule,  pain  and  tenderness  in  the  heel  are  caused  by  bruise, 
pressure  and  strain  directly  brought  on  by  overuse  of  the  feet.  It  is 
also  frequently  found  among  persons  who  do  constant  standing  or 
walking,  and  who  are  developing  a  condition  of  flat-foot.  This  pain- 
ful condition  is  frequently  known  as  policeman's  heel.     Again  the  pain 


Chart  No.  141 

Arch   Support  or  Foot  Rest  in  Position. 

Sponge  Rubber   Pad   Beneath   Heel. 


is  produced  by  inflammation  of  the  Calcaneal  Bursa,  which  is  known 
as  bursitis.  There  are  other  cases  where  the  pain  and  disturbances 
are  caused  by  growth  or  spur  on  the  Os  Calcis,  and  in  any  of  these 
cases,  whether  from  the  last  mentioned  causes,  or  which  may  be  ver- 
ified as  a  symptom  of  weak  or  broken-down  arch,  examination  of 
the  foot  should  be  made  the  same  as  for  flat-foot  or  arch  trouble  to 
learn  whether  the  pain  is  caused  by  flat-foot  condition. 

Treatment. — The  first  necessary  element  is  to  relieve  the  pressure 
on  the  Os  Calcis  or  heel.     This  is  best  done  by  fitting  the  patient  to 

204 


PAINFUL    HEEL  205 

a  pair  of  arch  supports,  taking  special  care  to  remove  all  pressure 
from  the  sensitive,  painful  area,  which  is  best  done  by  the  Tri-spring 
arch  support  as  illustrated.  Supports  should  be  elevated  posterially 
to  remove  the  pressure,  and  whether  the  pain  is  caused  by  oncoming 
flat-foot,  by  foot  strain,  or  is  the  result  of  inflammation  of  the  Bursa, 
or  caused  by  the  irritation  produced  by  the  growth,  this  method  will 
give  relief.  Pads  of  soft  felt,  sponge  rubber,  etc.,  hollowed  out  to 
receive  the  heel,  have  also  been  used  but  not  with  such  marked 
success. 

In  fitting  the  arch  support,  care  must  be  taken  to  fit  the  support 
so  that  the  plate  part   exending  under  the  heel  remains  away  from 


Chart  No.  142 
Korrecto  Arch   Support  Fitted  to  Relieve  Painful  Heel. 


the  Os  Calcis  so  that  the  actual  bearing  point  comes  forward.  (See 
Chart  Xo.  143.) 

Achillotenontitis  is  an  inflammation  of  the  tendon  itself  or  its 
sheath.  The  lower  part  of  the  tendon  is  abnormally  enlarged  and 
tender.  Bandaging  with  pads  on  either  side  of  the  tendon  is  benefi- 
cial, although  arch  supports  fitted  to  remove  excessive  pressure  should 
be  advised.  Rest  is  also  very  effective.  Climbing  of  stairs  should 
be  avoided. 

Talagia  and  Osteophytes  of  the  Os  Calcis. — The  Os  Calcis  is  not 
infrequently  the  seat  of  tuberculous  disease  and  must  be  treated  as 
a  tubercular  affection,  also  frequently  the  seat  of  gonorrheal  infection, 


206 


THE    HUMAN    FOOT 


when  it  is  often  enlarged  and  tender  to  lateral  and  plantar  pressure, 
a  painful  point  over  the  tuberosity  of  the  Os  Calcis  persistent  and 
troublesome.  Skiagraphy  shows  that  the  cause  is  frequently  irrita- 
tion and  osteophytes,  and  on  their  removal  disappears. 

This  tender  heel  has  been  called  Bursitis,  and  is  probably  due  to 
a  bursitis.     It  is  usually  an  accompaniment  of  flat-foot,  due  to  the 


Chart  No.   143 
Tri-Spring  Arch   Support  Fitted  to  Relieve  Painful  Heel. 


irritation  at  the  insertion  of  the  Plantar  ligaments.  When  this  con- 
dition is  caused  by  gonorrheal  infection,  the  trouble  is  often  diffused 
through  the  Tarsus,  or  causes  swelling  and  tenderness  about  the 
Astragalo-Scaphoid  joint.  Strains  and  wrenches  of  the  foot  fre- 
quently result  in  acute  tenosynovitis  of  the  Extensor  or  other  tendons. 
The  tendons  affected  are  swollen  and  motion  is  very  painful.     Rest, 


PAINFUL    HEEL  207 

tincture  of  iodine  applied  locally,  bandaging  and  the  application  of  an 
arch  support  which  has  been  fitted  to  the  Plantar  arch  so  as  to  remove 
pressure  from  the  heel  usually  effect  a  cure  in  a  short  time.  In- 
juries of  the  foot,  when  accompanied  by  much  ecchymosis  or  pain  at 
a  definite  point,  should  be  skiagraphed  to  ascertain  if  a  fracture  is 
present. 


CHAPTER  XXV 


HAMMER   TOE 

Hammer  Toe  is  a  contraction  of  one  of  the  toes,  usually  the  second 
or  the  third.  The  condition  is  one  of  flexion  of  the  second  Phalanx 
with  extension  of  the  third,  causing  the  pressure  on  the  ground  to 
be  sustained  by  the  Distal  Phalanx.  There  is  a  complete  or  partial 
contraction   of  the  ligaments,   and   the   controlling  muscles   are   also 


Chart  No.   144 
Foot  Shoeing  Hammer  Toe — Second  Toe. 


sometimes  involved.  A  callous  and  corn  are  usually  found  over  the 
upward  projecting  joint,  which  may  cause  considerable  annoyance. 
The  deformity  may  be  congenital  but  in  the  milder  forms  it  is  ac- 
quired principally  by  narrow,  short  shoes.  In  the  early  stages  little 
difficulty  is  experienced  by  the  patient.  However,  later  locomotion 
is  difficult  and  painful.  In  all  but  the  most  severe  cases  the  de- 
formity can  be  corrected  by  simple  mechanical  treatment. 

208 


HAMMER    TOE 


209 


Chart  No.   145 

Hammer   Toe   Spring  Adjusted  to  Toe 

and   Foot. 


Chart  No.  146 

Bottom  View  of  Hammer 

Toe   Spring. 


14 


210 


THE    HUMAN    FOOT 


If  the  case  is  not  of  too  long  standing,  the  hammer  toe  spring  will 
be  found  of  special  benefit,  and  will  gradually  straighten  the  toe. 
Author  uses  two  patterns  of  this  spring — one  with  extension  under 
the  Plantar  surface  of  the  foot  to  give  added  correction,  while  the 
other  is  made  with  a  short  spring  having  a  loop  for  the  toe  or  toes 
as  shown  in  the  illustrations.     (See  Charts  Nos.  146  and  147.)     When 


Chart  Nc.  147 
Spring   for    Hammer   Toe, 
Short  Spring. 


more  than  one  toe  is  affected  a  special  hammer  toe  plate  with  straps 
going  over  and  between  the  toes  is  used.  Kiro  or  absorbo  pads,  to 
relieve  the  pressure  of  the  shoe  from  the  apex  of  the  contracted  joint, 
are  also  beneficial,  affording  relief  from  pain  and  discomfort. 

A  contracted  position  of  several  toes  is  often  encountered,  which 
is  usually  due  to  improper  shoes  or  the  result  of  previous  paralysis 


■    HAMMER   TOE  211 

of  some  muscles  of  the  foot.     It  is  also  found  in  connection  with  the 
condition  spoken  of  as  contracted  foot. 

The  tendons  and  fasciae  are  found  to  be  shortened.  This  deformity- 
may  be  treated  in  the  same  way  as  a  contracted  toe.  Properly  made 
shoes  in  an  affection  of  this  kind  should  be  as  in  all  other  deformities. 


Chart  No.  148 
Kiro  Pads  for  Hammer  or  Contracted  Toe. 


OVERLAPPING  TOES 


Very  common  among  adults.  Owing  to  the  pressure  of  narrow 
shoes,  we  find  a  condition  of  overlapping  toes.  Xot  infrequently  de- 
formities of  this  kind  are  seen  in  infancy  and  are  apparently  congenital. 
The  greater  number,  however,  are  acquired.  Deflected  or  deformed 
toes  may  be  treated  by  manipulation  and  by  supporting  with  toe  flex, 
or  toe-right,  or  with  strips  of  adhesive  plaster.  In  severe  cases  the 
hammer  toe  spring  or  special  plate  should  be  used.  Care  should  be 
taken  to  avoid  crowding  the  toes  into  shoes  of  insufficient  length  and 
width.  This  deformity,  acquired  in  childhood,  usually  can  be  cor- 
rected with  exercise  and  proper  shoes. 


CHAPTER  XXVI 


WEAK  ANKLE— SPRAINED  ANKLE- 
TUBERCULAR  ANKLE 


WEAK  ANKLE 

Weak  Ankle  (In  Ankle)  is  a  posture  of  weakness  in  which  the  Inner 
Malleolus  descends  and  becomes  prominent.  It  is  often  associated 
with  the  out-toeing,  abducted  and  everted  foot,  and  also  with  knock- 


Chart  No.   149 
Showing   Bulging   Ankle   and   Rotation   of   Inner   Malleolus. 

212 


WEAK    ANKLE  213 

knee.  Very  frequently  weak  arch  or  fiat-foot  is  diagnosed  as  weak 
ankle.  The  weakness  usually  occurs  at  the  junction  of  the  Inner 
Malleolus  and  Astragaloid  region.  There  is  a  relaxing  and  stretching 
of  the  ligaments,  which  permit  an  inward  rotation  as  the  weight  is 
transmitted  into  the  foot.  The  treatment  is  that  of  weak-foot,  giving 
mechanical  support  to  the  Plantar  arch  directly  beneath  the  Inner 
Malleolus.  Weak  ankle  is  very  frequently  found  among  children, 
and  is  associated  with  flat-foot.  Adhesive  strapping,  stiffened  shoe 
counters,  elastic  bandages  and  corset  ankle  supporters  are  also  used. 
The  author's  method  is  to  give  mechanical  support  to  the  Plantar 
arch — ankle  articulation.  (See  Treatment  of  Weak  Foot — Chapter 
XVII.) 


Chart  No.  150 
Ankle    Support   for    Children. 


SPRAINED  ANKLE 


Sprain  of  ankle  is  a  common  injury,  which  consists  in  the  rupture 
of  some  of  the  fibers  of  the  lateral  ligament,  usually  the  external  of 
the  ankle  joint.  It  is  a  result  of  direct  or  indirect  violence  which 
may  rupture  or  tear  the  ligaments.  Swelling,  pain,  tenderness,  dis- 
ability and  ecchymosis  follow  rapidly  upon  the  injury.  Recovery 
under  local  applications  or  plaster  of  paris  splinting  is  slow.  If 
severe,  the  patient  should  be  made  comfortable  and  the  foot  elevated 
to  a  position  of  absolute  rest,  with  applications  of  cold  and  warm 
water  alternately.     Ligtone,  arnica  or  other  evaporating  lotions  may 


214  THE    HUMAN    FOOT 

be  used.  Then  the  foot  and  ankle  may  be  strapped  with  adhesive 
and  firmly  supported  to  prevent  any  further  strain.  Wearing-  an 
arch  support  in  the  shoe  after  it  has  been  properly  fitted  will  be  found 
a  great  aid.  Soreness  and  lameness  may  persist  for  months.  In 
injuries  with  great  ecchymosis.  fracture  of  the  tip  of  the  Malleolus 
should  be  expected  and  a  skiagraph  taken. 

TUBERCULOSIS  OF  THE  ANKLE 

Tuberculosis  of  the  ankle  occurs  usually  as  an  infection  from  one 
of  the  neighboring  bones,  especially  from  the  Astragalus  or  lower 
end  of  the  Tibia. 

In  children  this  disease  often  recovers  under  immobilization  of  the 
foot  and  ankle,  with  an  ankle  brace,  or  with  gypsum  splint,  and  sus- 
pension of  the  limb  by  crutches,  or  a  Thomas  splint,  and  the  usual 
tonic  treatment   for  tubercular  affections. 

In  other  cases  sinuses  will  appear  which  may  heal  under  simple 
aseptic  dressings  or  the  injection  of  a  saturated  solution  of  iodoform 
in  ether,  or  the  bismuth  vaseline  mixture.  Sometimes  the  ankle  joint 
has  to  be  opened  and  the  diseased  tissues  removed,  including  the 
original  focus.     This  often  involves  the  removal  of  the  Astragalus. 

The  location  of  the  bone  disease  may  be  determined  by  skiagraphy. 

It  is  very  important  that  the  orthopedic  operator  make  careful 
diagnosis  of  tubercular  ankle  as  it  sometimes  has  the  appearance  of 
flat-foot  or  other  common  foot  deformities. 


CHAPTER  XXVII 


TALIPES  OR   CLUB-FOOT 

Is  a  deformity  characterized  by  an  inversion,  torsion  and  depression 
of  the  front  part  of  the  foot,  with  an  elevated  heel.  In  walking-  on 
a  foot  deformed  in  this  manner  the  weight  of  the  body  is  not  borne 


Chart  No.  151 
Talipes  Varus. 


by  the  sole  of  the  foot,  but  by  the  outer  side,  and  in  extreme  cases 
by  the  dorsum  of  the  foot. 

There  are  four  varieties  of  club  foot,  but  in  any  case  the  foot  is 
twisted  out  of  its  natural  shape  and  an  actual  deformed  condition 
exists.     The  varieties  are  : 

215 


216  THE    HUMAN    FOOT 

Talipes  Equinus,  where  the  heel  is  elevated,  foot  extended  and 
the  patient  walks  on  the  balls  of  the  toes.     (See  Chart  No.  153.) 

Talipes  Varus,  the  inner  side  of  the  foot  raised  and  adducted  so 
that  the  weight  falls  to  the  outside  portion  of  the  foot. 

Talipes  Valgus  is  just  the  reverse  of  Talipes  Varus,  the  foot  being 
abducted  so  that  the  weight  falls  on  the  inner  portion  of  the  foot. 

Talipes  Calcaneus,  the  toes  are  raised  and  most  weight  is  carried 
on  the  heel. 

It  may  either  be  congenital  or  acquired. 

The  tissues  are  all  necessarily  affected  by  the  abnormal  position, 
and  the  skin,  muscles,  tendons  and  fascia  are  all  altered. 

In  congenital  cases  of  club-foot,  even  in  cases  at  full  term,  the 
Scaphoid  articulates  with  the  side  of  the  head  of  the  Astragalus  in- 
stead of  with  the  anterior  surface.  The  articulation  is  also  more 
towards  the  underside  of  the  Astragalus,  the  head  being  uncovered. 

The  Scaphoid  may  be  displaced  to  such  an  extent  at  one  side  as 
to  articulate  at  one  end  with  the  tip  of  the  Internal  Malleolus.  The 
distortion  in  the  shape  of  the  bones  in  infants  is  of  little  importance, 
as  the  ends  are  largely  cartilaginous.  The  Tarsal  bones,  however, 
are  not  in  a  normal  position.  As  the  Cuneiform  bones  are  intimately 
connected  with  the  Scaphoid,  it  is  also  displaced,  the  same  being  true 
of  the  Metatarsals  and  the  Phalanges.  The  long  axis  of  the  front 
part  of  the  foot  forms  a  right  angle,  sometimes  an  acute  angle,  with 
the  axis  of  the  leg.  The  Cuboid  is  also  displaced  and  does  not  artic- 
ulate with  the  front  of  the  Os  Calcis,  the  Facet  also  inclining  ob- 
liquely to  the  inner  side. 

In  cases  that  are  fully  developed,  and  in  older  children  or  adults, 
there  is  a  marked  alteration  in  the  shape  of  the  bones.  The  bones 
noticed  to  have  been  altered  in  shape  and  position  are  the  following, 
viz.,  the  Os  Calcis,  Cuboid,  Astragalus  and  Scaphoid. 

By  the  elevation  of  its  tuberosity  the  Os  Calcis  is  drawn  from  a 
horizontal  into  a  position  nearly  vertical.  It  is  more  or  less  rotated 
on  its  vertical  axis,  its  anterior  extremity  being  directed  outward  and 
the  posterior  extremity  inward,  this  causing  the  anterior  articulating 
facet  to  be  oblique  to  the  axis  of  the  bone. 


TALIPES    OR    CLUB-FOOT 


217 


The  connection  of  the  Cuboid  with  the  Os  Calcis  remains,  but 
follows  the  inward  direction  of  the  anterior  extremity  of  the  foot. 

The  Astragalus  does  not  rotate  on  the  vertical  axis,  but  is  de- 
pressed forward  on  its  horizontal  axis  so  that  only  the  posterior  por- 
tion of  its  superior  articular  surface  is  in  contact  with  the  inferior 
articular  surface  of  the  Tibia,  the  anterior  part  of  its  anterior  facet 
projecting  beneath  the  skin  of  the  Dorsum  of  the  foot.  Other  than 
the  displacement  previously  mentioned,  it  is  altered  by  the  twisting 


Chart  No.  152 
Double   Talipes  Varus. 


inward  of  the  head  and  neck,  so  that  the  anterior  articular  surface 
looks  inward  instead  of  forward,  and  the  disposition  of  the  cartilage 
at  the  articulating  surface  of  the  head  of  the  Astragalus  is  neces- 
sarily altered.  The  three  Cuneiforms  and  the  three  Metatarsal  bones 
being  closely  connected  with  the  Scaphoid,  are  more  twisted  to 
the  inner  side  than  is  the  case  with  the  Cuboid.  The  Metatarsals  are 
not  all  alike  involved  in  the  rotation  from  without  inward,  and  are 


218  THE    HUMAN    FOOT 

spread  out  in  such  a  way  that  the  anterior  part  of  the  foot  is  abnor- 
mally enlarged.  There  are  other  alterations  in  the  position  of  the 
foot  which  take  place,  due  to  pressure  and  the  effect  of  locomotion  on 
the  distorted  bones.  The  different  tendons  take  an  abnormal  direc- 
tion and  in  general  are  carried  farther  to  the  inner  side  than  is  normal, 
especially  that  of  the  Tibialis  Anticus,  which  is  the  common  extensor 
of  the  toes  and  the  long  extensor  of  the  great  toe. 

Synovial  Bursae  may  form  on  the  outer  edge  and  back  of  the  foot, 
which  at  times  become  inflamed  and  purulent.  There  are  often 
corns  and  callosities  present  on  the  skin,  due  to  the  pressure  from 
walking. 

In  cases  of  club-foot  no  changes  have  been  as  yet  found  in  the 
nerves  or  spinal  cord. 

In  severe  cases  there  may  be  slight  alteration  in  the  shape  of  the 
Femur  and  a  laxity  at  the  knee  joint.  The  Tibia  and  Fibula  have  been 
found  altered.  In  congenital  club-foot  the  muscles  are  never  par- 
alyzed, but  the  contracted  muscles  appear  more  developed  than  the 
lengthened  ones.  From  disuse  the  muscles  of  the  leg  atrophy,  con- 
sequently making  the  leg  smaller  and  the  foot  shorter  than  normal. 

There  is  also  a  change  in  the  ligaments  and  fascia,  not  confined 
to  the  severe  and  older  cases  but  always  present.  The  ligaments 
and  fascia  affected  by  contraction  are  the  Plantar  ligaments  and 
fascia,  the  internal,  lateral  and  posterior  ligaments. 

Causes. — Club-foot  is  usually  a  congenital  deformity,  but  it  can 
also  be  acquired  after  the  impairment  of  muscular  power,  such  as  in 
paralysis,  and  after  accident. 

The  chief  theories  advanced  in  explaining  the  origin  of  club-foot 
are  as  follows  : 

1.  Abnormal  compression  while  in  utero. 

2.  Retraction  or  paralysis  of  muscles,  depending  or  not  on  lesions 
of  the  nervous  system  occurring  in  utero. 

3.  A  malformation  depending  upon  arrest  of  development  of  the 
foot. 

Diagnosis. — In  walking,  club-foot  causes  great  inconvenience  to 
the  patient,  although  in  uncorrected  cases  skill  and  agility  of  locomo- 


TALIPES    OR    CLUB-FOOT  219 

tion  are  acquired  even  though  the  deformity  remains  unchanged.  Dis- 
comfort is  also  occasioned  by  the  formation  of  bursae  and  callosities 
which  inflame  over  the  unprotected  portion  of  the  foot,  limiting  the 
patient's  amount  of  activity. 

The  distortion  presents  an  inward  twist  of  the  foot,  with  a  de- 
pressed position  of  the  outer  edge.  To  the  touch  the  Tendo-Achillis 
is  firm  and  hard;  the  Plantar  fascia  will  also  be  found  short  and  hard 
on  palpation.  (There  is  a  projection  on  the  inner  side  of  the  ver- 
tical axis  of  the  leg,  the  fore  part  of  the  foot.)  The  fore  part  of  the 
foot  projects  to  the  inner  side  of  the  vertical  axis  of  the  leg,  the  ten- 
dinous end  of  the  Os  Calcis  being  raised  and  turned  inward. 

The  head  of  the  Astragalus  and  Cuboid  project  under  the  skin,  and 
there  is  usually  an  atrophy  of  the  muscles  of  the  leg.  There  is  a 
prominence  of  the  External  Malleolus,  while  the  internal  cannot 
readily  be  felt. 

Club-foot  is  readily  recognized. 

By  obtaining  a  history  of  the  case,  diagnosis  can  be  established 
between  the  congenital  and  noncongenital  forms  of  club-foot.  Par- 
alysis is  the  only  common  cause  of  acquired  club-foot,  and  it  can  be 
recognized  by  the  evidence  of  paralysis  of  the  muscles  on  the  anterior 
and  external  surface  of  the  leg. 

The  deformity  will  not  correct  itself,  and  if  left  uncorrected  re- 
mains the  most  obstinate  of  malformations. 

If  skilled  care  and  attention  is  given,  the  deformity  is  said  to  be 
always  curable. 

Treatment. — Treatment  of  club-foot  varies  according  to  the  patient 
and  the  duration  and  nature  of  the  deformity. 

The  treatment  should  be  purely  mechanical,  or  operative  and 
mechanical. 

The  object  of  treatment  is  to  correct  the  distortion  and  to  retain 
the  foot  in  a  correct  position  until  any  return  of  the  deformity  is 
impossible. 

Specially  made  braces  of  a  scientific  corrective  nature,  when  ap- 
plied to  the  child,  will  do  much  in  assisting  toward  a  cure.  Shoes  built 
with  a  corrective  object  in  mind  also  aid,  although  in  the  adult  shoes 


220 


THE    HUMAN    FOOT 


and  braces  can  only  add  to  the  comfort  and  possibly  remove  undue  and 
uneven  pressure. 

TALIPES  EQUINUS 

Is  the  name  given  to  a  condition  in  which  the  foot  is  held  in  a 
position  of  Plantar  flexion,  and  rendering  Dorsal  flexion  to  the  proper 
extent  impossible.     It  is  known  also  as  pes  equinus  and  horse  heel. 

It  is  very  rarely  a  congenital  deformity  but.  as  an  acquired  one,  it 


Chart  No.   153 
Talipes   Equinus. 

is  very  common,  especially  in  its  milder  degree.  In  the  acquired  form 
all  degrees  are  encountered,  from  a  condition  in  which  the  foot  can- 
not be  flexed  beyond  a  right  angle  to  one  in  which  the  foot  and  leg  are 
nearly  in  a  continuous  line. 

In  milder  forms   the  deformity  is  of  less  importance   than  other 
forms  of  talipes. 


TALIPES    OR    CLUB-FOOT 


221 


This  affection  in  a  light  degree  may  cause  a  person  to  limp  in 
walking,  because  in  carrying  the  leg  back  at  the  end  of  the  step  the 
foot  must  be  bent  more  than  to  a  right  angle. 

The  changes  of  the  structure  in  talipes  equinus  are  slight.  In 
many  cases  there  is  a  shortening  of  the  Tendo-Achillis  and  a  conse- 
quent alteration  in  the  shape  of  the  bones  of  the  foot. 


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Chart  No.   154 
Mild  Case  of  Talipes  Varus. 


The  increased  depth  of  the  arch  or  cavus  is  primarily  due  to  a 
falling  downward  of  the  fore  foot  at  the  Medio-Tarsal  joint,  in  fact 
in  many  cases  it  is  due  more  to  the  former  than  to  the  Plantar  flexion 
of  the  Calcaneum. 

Equinus  in  the  lighter  degree  is  the  most  common  of  the  forms  of 
talipes  acquired  in  later  life.  Although  anterior  poliomyelitis  is  the 
cause  most  common,  it  is  not  as  important  in  the  etiology  of  this 
as  of  other  varieties  of  deformity. 


222  THE    HUMAN    FOOT 

The  detection  of  talipes  equinus  is  so  simple  that  it  requires  no 
description. 

Contracted  Foot  (Non-Deforming  Club-Foot.) — This  form,  which 
is  a  slight  degree  of  talipes  equinus,  deserves  a  separate  considera- 
tion. It  is  characterized  by  a  moderate  degree  of  limitation  of 
normal  dorsal  flexion  "of  the  foot.  It  is  known  under  the  name  of 
"non-deforming  club-foot,"  and  also  as  "contracted  foot."  It  is  due 
to  a  contraction  of  the  posterior  muscles  of  the  leg,  principally  the 
Gastrocnemius,  or  the  muscles  of  the  sole  of  the  foot.  It  may  occur 
in  flat-foot,  the  weakened  foot,  and  in  like  conditions  in  which  it  is 
probably  dvie  to  irritation  and  possibly  reflex  in  character. 

It  is  frequently  associated  with  Metatarsalgia,  possibly  as  the 
cause  or  as  the  result  of  irritation  from  the  foot.  It  is  often  seen  in 
sciatica,  when  flexion  of  the  foot  beyond  a  right  angle  is  restricted  and 
very  painful.  Sometimes  cases  are  encountered  in  elderly  persons, 
due  to  a  stiffening  and  loss  of  elasticity  in  the  posterior  muscles.  Oc- 
casionally it  exists  in  hysterical  persons,  more  often  in  women,  with 
other  obvious  causes.  In  adults  and  children  apparently  in  perfect 
health,  with  no  demonstrable  cause,  it  is  often  noticed,  also  after 
sprains  of  the  ankle. 

TALIPES  VARUS 

Or  sometimes  called  Equino- Varus,  is  a  common  form  of  con- 
genital club-foot  and  is  sometimes  accompanied  by  other  congenital 
defects  such  as  hare  lip. 

TALIPES  VALGUS 

This  is  the  condition  of  the  foot  abducted  and  everted.  The  side 
becomes  flattened  and  the  inner  border  comes  in  contact  with  the 
ground.  Considerable  pain  is  experienced  after  walking  a  short  dis- 
tance. This  deformity  is  occasionally  due  to  absence  of  the  Fibula. 
The  acquired  variety,  which  is  not  uncommon,  results  from  paralysis 
of  the  Tibial  muscles  or  from  spastic  contraction  of  the  Peronei,  the 
condition  and  appearance  closely  resembling  flat-foot. 


TALIPES    OR    CLUB-FOOT  223 

TALIPES  CALCANEUS 

Is  a  condition  in  which  the  foot  is  held  in  a  position  of  dorsal 
flexion.  It  is  much  less  common  than  equinus,  and  usually  of  para- 
lytic origin,  although  cases  following  injury  or  disease,  or  distortion, 
are  occasionally  encountered.  There  are  several  varieties  of  the  de- 
formity. It  may  exist  alone  or  associated  with  valgus,  in  which  case 
it  is  known  as  talipes  calcaneo  valgus.  Occasionally  it  exists  as  a 
congenital  deformity  in  a  varying  degree.  At  times  only  a  slight 
prominence  of  the  heel  is  noticed,  when  at  others  it  may  be  so  severe 
that  the  Dorsum  of  the  foot  is  almost  against  the  shin. 

Acquired  talipes  calcaneus  is  most  often  the  result  of  paralysis 
of  the  muscles  of  the  calf  of  the  leg,  due  to  anterior  poliomyelitis.  It 
also  occurs  in  chronic  diseases  of  the  ankle  as  a  result  of  muscular 
irritability,  from  rupture  or  division  of  the  posterior  muscles  of  the 
leg,  and  from  anterior  cicatrices.     Sometimes  it  exists  in  hysteria. 

On  inspection  the  deformity  is  readily  noticed  and,  as  the  name 
implies,  the  patient  walks  on  an  elongated  heel. 


CHAPTER  XXVIII 


PES   CAVUS— HUMP-FOOT— HOLLOW 
CLAW-FOOT 


PES  CAVUS  OR  HOLLOW-FOOT 

In  this  deformity  the  anterior  part  of  the  foot  is  drawn  backward 
and  the  arch  increased.  The  Plantar  arch  is  increased  in  height  and 
greater  weight  is  placed  upon  the  Metatarsal  bones  and  posterior 
tuberosity  of  the  Os  Calcis.    All  degrees  of  severity  are  encountered. 


Chart  No.  155 
Pes   Cavus   or   Contracted   Foot. 

In  some  cases  the  ball  and  heel  of  the  foot  are  in  contact,  the  arch  be- 
ing converted  into  a  deep  sulcus  or  groove.  There  are  three  forms  of 
Pes  Cavus  which  are  recognized.  The  first  is  due  to  the  contraction 
of  the  Peroneus  Longus  and  the  deformity  resulting. 

224 


PES   CAVUS 


225 


The  second  is  the  result  of  paralysis  of  the  Gastrocnemius  and 
Soleus  muscles,  the  sole  of  the  foot  is  lowered,  and  by  the  action  of 
the  long  flexors  on  the  anterior  part,  a  cavus  foot  is  developed.  In 
addition  to  this  there  may  be  Varus,  or  Valgus  distortion. 

The  third  form  may  be  acquired  but  is  usually  congenital.  This 
condition  is  due  to  a  marked  depression  of  the  heads  of  the  Metatarsal 
bones  with  a  forced  extension  of  the  first  Phalanges  and  a  flexion  of 
the  last. 


Chart  No.  156 
Showing   Tri-Spring  Arch   Support  Fitted  High  into  Arch   for  Pes   Cavus. 


Paralysis  of  the  Interossei  and  Lumbricalis  muscles,  and  of  those 
muscles  inserted  into  the  Sesamoid  bones  of  the  great  toe,  is  the 
origin  of  this  affection. 

Frequently  the  ligaments  are  contracted  and  cause  a  clawing  up- 
ward of  the  toes.  With  the  contracted  foot,  corns  and  painful  cal- 
louses form  at  the  ball  of  the  foot  and  occasionally  about  the  heel. 

To  correct  this  deformity  with  mechanical  appliances  is  very  dif- 
ficult. Braces,  however,  that  will  give  support  and  restore  balance 
to  the  foot  and  weight  carrying  points  can  be  made  good  use  of  with 

15 


226 


THE    HUMAN    FOOT 


satisfactory  results.  Where  the  toes  are  badly  contracted  in  the  form 
of  hammer  toes,  a  hammer  toe  plate  or  spring  should  be  used  to 
assist  in  straightening  the  same.  The  object  is  to  build  up  the  de- 
ficiencies and  lessen  the  pressure  and  bearing  points  in  all  parts  of 
the  foot. 

HUMP-FOOT 

Flexion  at  the  first  Metatarso-Cuneiform  joint,  with  enlargement 
of  the  bones  on  the  Dorsal  surface,  causes  a  deformity  known  as 
hump-foot.     Short  shoes  with  high  arch  and  tight  vamp  produce  this 


Chart  No.  157 
Hump-Foot,  with  Metatarsalgia. 


condition.  This  affection  is  often  very  painful,  and  can  be  relieved 
by  wearing  proper  shoes,  rest,  and  the  applying  of  absorbo  or  kiro 
pads  to  prevent  further  pressure  or  friction  of  the  shoe. 


HOLLOW  CLAW-FOOT 

In  hollow  claw-foot  there  is  a  cavus  combined  with  hyperextension 
of  the  proximal  and  flexion  of  the  other  segments  of  the  toes.  This 
condition  is  frequently  associated  with  paralysis  of  the  Interossei  and 
Lumbricales.  The  affection  is  very  similar  to  Pes  Cavus  and  the 
same  treatment  must  be  used. 


CHAPTER  XXIX 


KNOCK-KNEE— BOW-LEGS— DEFORMITIES 
OF  THE   KNEE 


KNOCK-KNEE 

Knock-Knee  (In-Knee,  Genu  Valgum)  is  a  deformity  where  the 
knee  is  thrown  inward,  a  perpendicular  line  drawn  from  the  head  of 
the  Femur  to  a  point  midway  between  the  Malleoli.  There  is  an  out- 
ward curve  with  the  bones  of  the  thigh  and  leg  which  may  occur  in 
one  or  both  limbs. 


Chart  No.  158 
Knock-knee    Condition    in    a    Boy. 


This  deformity  is  usually  due  to  rachitis,  but  the  mild  grades  may 
be  the  cause  of  static  conditions  in  delicate  or  otherwise  normal  chil- 
dren. It  also  may  be  due  to  other  causes,  also  frequently  found 
associated   with    flat-foot   which   is  a   predisposing  cause,   and   often 

227 


228 


THE    HUMAN    FOOT 


follows  tuberculosis  of  the  knees  and  infantile  paralysis.  Knock-knee 
usually  manifests  itself  in  children  of  the  age  between  two  and  four 
when  commencing  to  walk.  It  often  occurs  in  adolescents  who  stand 
too  much  on  their  feet  or  carry  heavy  loads  and  consequently  require 
supporting  of  the  arch.  The  deformity  is  principally  in  the  Femoral 
Condyles,  or  at  the  upper  end  of  the  Tibia,  or  alike  in  both.     Upon 


Chart  No.  159 
Knock-knee. 


flexion  of  the  knee,  knock-knee  may  disappear.  Due  to  stretching  of 
the  Internal  Lateral  ligament  the  knee  is  somewhat  loose,  then  being 
turned  out  unless  instinctively  turned  forward  or  in  as  a  protection 
to  the  weak  inner  side  of  the  knee.  Mechanical  braces  are  indicated 
that  will  afford  proper  amount  of  correction  in  drawing  the  limbs  to 
a  straight  line. 


KNOCK-KNEE— BOW-LEGS 


229 


Knock-Knee  with  Weak  Foot. — Regularly  weak  feet  are  found 
with  rachitic  and  static  knock-knee  aggravating  the  difficulty.  Knock- 
knee  is  usually  bilateral,  although  it  may  occur  on  one  side  only, 
or  be  paired  with  a  bow-leg  on  the  opposite  side.  An  anterior  curva- 
ture of  the  Tibia  is  frequently  found  with  knock-knee.  Knock-knees 
and  bow-legs  have  been  often  found  to  exist  in  the  same  individual, 
and  also  combined  with  anterior  curves  of  the  Tibia  and  of  the  Femur. 
In  walking  with  knock-knees  the  knees  rub  together  and  the  feet  are 
not  properly  placed,  occasioning  a  stiff  and  awkward  gait.  In  ex- 
treme cases  walking  is  almost  impossible. 


Chart  No.   160 
Bow-legs  in  Child. 


BOW-LEGS 

Bow-Legs  and  Genu  Varum  or  out-knee  is  the  opposite  deformity 
to  knock-knee.  The  knee,  by  bending  of  the  Femur  or  Tibia  or  both, 
is  carried  outward  or  by  a  deformity  of  the  Condyles  of  the  Femur 
or  Tibial  tuberosities.     This  deformity  may  be  caused  by  injuries 


230 


THE    HUMAN    FOOT 


with  outward  displacement  of  the  knee,  or  followed  by  a  gradual 
yielding  due  to  insufficient  stability.  There  is  also  a  paralytic  genu 
varum  due  to  relaxation  of  the  External  Lateral  ligament  of  the  knee 
from  continual  strain.  The  cause  most  common  is  due  undoubtedly 
to  rickets,  and  the  yielding  is  usually  most  below  the  knee,  which 
is  the  usual  bow-leg  deformity. 

The  greatest  bending  may  take  place  below  the  Tibial  tuberosities 
or  at  the  junction  of  the  middle  and  lower  third. 


Chart  No.  161 
Bow-leg   Brace   with   Thigh    Straps. 


DEFORMITIES  OF  KNEE 

Congenital  Deformities. — Congenital  flexion  is  a  condition  noticed 
in  babies,  occurring  on  one  or  both  sides.  In  the  light  and  middle 
cases  it  yields  to  daily  stretching. 

The  more  severe  forms  may  be  associated  with  pes  calcaneus,  and 
at  times  are  very  resistant,  requiring  tenotomy  (the  section  of  a 
tendon)  of  the  ham-strings,  forcible  stretching  and  retentive  apparatus. 


KNOCK-KNEE— BOW-LEGS  231 

A  snapping  or  clicking  knee  is  very  often  seen  in  young  babies. 
The  ligaments  appear  to  be  lax,  which  frequently  permits  a  partial 
dislocation  of  the  Tibia  outward.  This  condition  may  be  a  con- 
genital one,  and  is  usually  overcome  by  bandaging,  strapping  or 
mechanical  appliances. 

Congenital  Hyperextension  of  the  Knee  (Congenital  genu  recurva- 
tum;  Congenital  absence  of  the  Patella;  Congenital  dislocation  of 
the  Knee). 

In  affections  of  this  kind  the  baby  is  usually  born  breech  first, 
thighs  being  flexed  on  the  abdomen,  the  knees  hyperextended  and  the 
feet  beside  the  face ;  unilateral  cases  also  occur.  This  deformity  is 
due  to  uterine  pressure  on  the  extended  knee  or  knees ;  at  times  there 
is  ligamentous  laxity  of  a  number  of  joints.  The  Tibia  is  displaced 
forward  on  the  Condyles  and  the  knee  lax,  allowing  lateral  and  slid- 
ing movements.  The  Patella  in  the  first  few  months  is  not  felt,  but 
it  can  be  usually  before  the  first  year,  although  it  may  remain  very 
small. 

The  hyperextension  of  the  knee  is  often  considerable,  and  it  may 
be  impossible  to  bring  the  leg  back  beyond  a  straight  line.  Popliteal 
creases  may  not  be  absent,  while  creases  in  front  of  the  knee  may  be. 
The  Condyles  of  the  Femur  are  abnormally  prominent  in  the  Popliteal 
space.  In  cases  of  this  kind  the  legs  must  be  held  in  position  and 
gradually  flexed,  by  strapping  the  patient  to  a  frame,  bent  under  the 
knees  or  by  other  appliances,  otherwise  the  patient  will  experience 
difficulty  in  walking  and  have  loose  knees.  This  condition  rarely 
causes  knock-knee.  If  extension  and  displacement  is  prevented  and 
the  flexion  gradually  increased,  the  deformity  may  be  overcome  after 
a  few  months,  during  which  time  a  joint  supporting  appliance  should 
be  worn,  the  condition  then  becoming  practically  normal. 

Acquired  Deformities. — Acquired  genu  recurvatum  is  caused  by 
stretching  of  the  Posterior  ligament  of  the  knee  joint  when  motion  is 
not  sufficiently  checked  by  the  ham-string  muscles.  In  a  mild  form 
it  is  seen  in  delicate  children  and  also  is  common  in  inveterate  pes 


232  THE    HUMAN    FOOT 

equinus  and  equmo-varus ;  also  after  poliomyelitis  affecting  the  knee 
flexors,  especially  when  the  heel  cord  is  contracted.  We  frequently 
find  occurrences  of  genu  recurvatum  in  the  hypotonus  of  locomotor 
ataxia  and  of  coxitis,  especially  in  the  latter  affection  if  traction  is 
made  from  adhesive  strips  applied  only  below  the  knee  and  when 
hyperextension  is  not  prevented  by  a  steel  band  behind  the  knee.  In 
the  paralytic  forms  and  in  that  complicating  locomotor  ataxia,  an 
apparatus   to   prevent  lateral   motion  and  to  keep   the  knee   slightly 


Chart  No.  162 
Bow-leg  Brace   Extending  to   Knee. 


flexed  should  be  adjusted.  In  the  rachitic  form  the  bending  is  usually 
below  the  knee. 

Bursitis  About  the  Knee. — It  is  necessary  to  have  a  knowledge 
of  the  location  of  the  bursa  about  the  knee  in  order  to  differentiate 
knee  affections  and  to  apply  proper  treatment.  It  should  be  remem- 
bered that  by  repeated  trauma  a  bursa  will  be  irritated  and  is  liable 
to  the  various  infections  to  which  serous  membranes  are  subject. 

Prepatellar  Bursitis  or  Housemaid's  Knee. — It  is  frequent  in  those 
people  who  work  in  a  kneeling  posture  and  due  to  the  pressure.     It 


KXOCK-KXEE— BOW-LEGS  233 

appears  as  a  large,  rounded,  tense  swelling  in  front  of  the  Patella,  and 
usually  is  filled  with  a  gelatinous  fluid,  sometimes  suppurating. 

Pretibial  Bursitis. — The  Pretibial  Bursa  lies  between  the  front  of 
the  Tibia  and  the  Ligamentum  Patella.  When  distended  it  projects 
either  side  of  the  latter  and  appears  as  a  tense,  elastic  or  fluctuating 
swelling.  In  diseases  of  the  knee  joint  it  is  often  affected,  but  it  often 
is  involved  without  affecting  the  knee.  If  filled  with  pus  it  should 
be  evacuated,  disinfected  and  scraped,  otherwise  rest  and  strapping 
are  usually  enough. 

Hypertrophied  synovial  fungi  below  the  Patella  may  also  cause 
enlargement  on  either  side  of  the  Ligamentum  Patella. 

Pretubercular  Bursitis. — There  is,  in  some  individuals,  located  in 
front  of  the  Tibial  tubercle  a  small  bursa  which,  after  injury  or 
otherwise,  may  become  inflamed  and  give  rise  to  a  small  tense  swell- 
ing which  may  be  unilateral  or  bilateral,  often  causing  pain,  especially 
in  climbing  stairs.  This  condition  at  times  is  \_ery  persistent,  giving 
rise  to  a  permanent  enlargement  of  the  tubercle.  Painting  with  iodine, 
strapping  and  rest  usually  afford  prompt  relief.  Many  of  these  cases 
in  adolescents  are  due  to  a  diastasis  or  fracture  of  the  tubercular 
epiphysis  (Osgood),  a  narrow  tongue  of  bone  jutting  down  the  upper 
Tibial  epiphysis.  After  a  fall  or  a  blow  in  cases  of  this  kind,  pain, 
swelling,  tenderness  and  disability  about  the  Tibial  tubercle  comes  on 
suddenly. 

The  bursa  under  the  ham-string  tendons  sometimes  becomes 
distended  or  inflamed  and  may  require  tapping  and  compression  or 
more  vigorous  treatment. 

ACCIDENTS  TO  THE  PATELLA  AND  ITS  LIGAMENTS 

Slipping  Patella. — The  Patella  after  once  being  dislocated  may 
acquire  the  habit  of  slipping,  usually  to  the  outer  side.  This  often 
occurs  in  knock-knee,  and  it  is  usually  sufficient  to  correct  the  de- 
formity. When  it  is  due  to  other  causes  it  usually  requires  a  surgical 
operation,  which  will  be  unnecessary  to  explain  here. 

Tuberculosis  of  the  Patella. — The  Patella  is  often  diseased  in  tuber- 
culosis of  the  knee,  but  there  is  a  probability  that  the  process  may 


234  THE    HUMAN    FOOT 

begin  in  the  Patella.  To  recognize  this  condition  early  is  very  im- 
portant, as  a  scraping  operation  or  a  dissection  of  the  Patella  if  needed, 
when  performed  in  time,  will  often  prevent  infection  of  the  joint. 

The  symptoms  are  pain  in  and  swelling  in  front  of  the  Patella, 
which  may  contain  serum,  with  flocculi  and  tuberculous  debris.  By 
feeling  the  anterior  surface  of  the  Patella  you  may  find  it  eroded,  or 
erosion  may  be  revealed  by  a  skiagram. 

Ankylosis  of  the  Patella. — After  an  infection  of  the  knee  joint  the 
Patella  may  become  united  to  the  articular  groove  of  the  Femur. 
If  it  has  become  ankylosed  while  the  knee  joint  was  flexed  it  stops 


Chart  No.  163 
Tubercular    Knee. 


extension  and  its  adherence  in  any  position  removes  all  voluntary 
extension  and  flexion.  Any  motion  present  will  be  due  to  a  laxity  of 
the  Ligamentum  Patella.  When  ankylosis  is  fibrous  it  permits  rock- 
ing, and  when  bony  the  Patella  is  absolutely  fixed.  When  the  Patella 
is  adherent  there  is  often,  but  not  always,  more  or  less  adherence 
between  the  Tibia  and  Femur.  If  the  knee  joint  is  stiff  in  extension, 
adhesion  of  the  Patella  is  of  no  importance.  If  the  knee  is  flexed  it 
may  be  straightened  after  the  Patella  is  loosened. 


CHAPTER  XXX 


RHEUMATISM— GOUT— OTHER  JOINT 
AFFECTIONS 


RHEUMATISM 

Rheumatism  is  an  affection  which  is  said  to  be  the  cause  of  many 
joint  diseases,  with  which  it  really  has  nothing  to  do.  It  is  a  con- 
stitutional disease  affecting  the  joints,  muscles  and  connective  tissue. 
In  the  articular  rheumatism  the  painful  symptoms  seem  to  pass  from 
one  joint  to  another.  Often  the  manifestations  of  arthritis  deformans 
are  confused  with  the  true  rheumatic  affections,  and  as  in  simple 
acute  synovitis  of  the  knee,  in  which  no  cause  is  known ;  it  is  diag- 
nosed by  many  practitioners  as  a  rheumatic  joint  affection.  Also 
obscure  cases  of  joint  diseases  are  likely  to  be  placed  in  this  class. 
The  structure  attacked  in  true  rheumatic  joint  affection  is  chiefly 
in  the  Synovial  membrane,  which  secretes  much  fluid  and  takes  on 
a  proliferative  action,  with  enlargement  of  the  Synovial  tufts.  This 
condition  may  give  rise  to  swelling  of  a  joint  without  necessarily 
the  presence  of  much  effusion,  and  the  capsule  becomes  thickened, 
although  in  prolonged  cases  the  cartilage  is  likely  to  remain  intact, 
but  may  become  fibrillated  at  the  edges  and  eroded  in  spots,  while 
vascular  pannus  spreads  in  from  the  edges.  The  whole  tendency 
is  away  from  separation  and  toward  connective  tissue  formation. 
The  knee  is  most  often  attacked  by  rheumatic  joint  affections, 
then  the  foot,  elbow,  hand,  shoulder,  head,  etc.  They  are  mon- 
articular or  polyarticular.  Rheumatic  affections  more  frequently  at- 
tack youths  and  people  of  middle  age.  The  etiology  of  chronic  rheu- 
matic joint  disease  is  obscure  and  little  understood,  and  may  be 
primary  or  secondary  to  acute  attacks,  or  also  it  may  follow  a  depres- 

235 


236  THE    HUMAN    FOOT 

sion  in  the  general  condition,  or  occur  as  the  result  of  exposure,  or 
from  some  injury.  In  the  treatment  of  foot  disorders,  it  is  not  at  all  un- 
common to  mistake  the  pains  and  symptoms  of  flat-foot  conditions  for 
rheumatism.  Where  complaints  of  rheumatism  in  the  feet  and  lower 
limbs  are  made,  it  is  well  to  make  careful  inquiries  as  to  the  history 
of  the  case,  and  take  every  precaution  to  examine  the  feet  for  flat- 
foot  conditions.  It  must  also  be  remembered  that  flat-foot  may  co-exist 
with  rheumatism,  and  not  infrequently  has  flat-foot  been  shown  to 
have  been  caused  by  rheumatism. 

GOUT 

Gout  is  a  painful  constitutional  disease,  acute  or  chronic,  with 
joint  inflammation  and  chalk  deposits  and  an  increase  of  uric  acid  in 
the  blood.  .  It  is  a  joint  affection  with  constitutional  manifestations. 
It  usually  begins  as  an  acute  attack  followed  by  inflammation.  The 
common  seat  of  affection  is  the  Metatarso-Phalangeal  joint  of  the 
great  toe.  It  looks  very  much  like  a  bunion  on  account  of  the  swells 
ing  as  it  usually  manifests  itself  in  the  great  toe  joint,  although  the 
heel  and  ball  are  sometimes  affected.  It  gives  rise  to  inflammation, 
swelling  and  redness,  accompanied  by  severe  pain.  It  is  usually  neces- 
sary to  remove  the  shoe,  and  a  thick  woolen  stocking  worn  for  protec- 
tion. In  articular  gout,  the  position  of  the  bones  is  not  changed,  unless 
a  sufficient  quantity  of  urates  is  deposited  to  cause  local  absorption 
from  pressure.  Gout  requires  systemic  treatment  similar  to  rheu- 
matism ;  local  applications  are  also  beneficial. 

Another  of  the  many  painful  ailments  of  the  feet  is  rheumatic 
gout,  which  is  very  serious.  This  is  also  due  to  uric  acid  deposits 
in  the  blood. 

It  is  found  among  persons  who  are  of  sedentary^habits  and  who 
eat  an  excess  of  animal  foods  and  partake  of  rich  wines. 

Treatment. — Inasmuch  as  gout  is  a  constitutional  disease  it  must 
be  treated  by  the  physician  as  such.  It  would  appear  from  examina- 
tion of  a  gouty  foot  that  it  is  of  local  origin  which  then  might  be 
treated  as  such.     The  aid  in  giving  relief  consists  of  wearing  wide 


OTHER   JOINT    AFFECTIONS  237 

soft  kid  shoes  with  a  firm  protective  sole.  Woolen  socks  should  be 
worn,  and  if  pain  is  severe,  hot  applications  may  be  used  as  a  tem- 
porary relief. 


JOINT  AFFECTIONS  SIMULATING  RHEUMATISM 

A  careful  study  of  anatomy  reveals  the  fact  that  the  joints  or 
articulations  are  a  very  important  part  of  the  body  and  must  be  care- 
fully kept  in  mind  in  all  orthopedic  treatments.  Inflammatory  affec- 
tions of  the  joints  are  of  the  most  diverse  character  and  may  be  due 
to  injury,  infection,  rheumatism  or  gout  and  other  constitutional 
conditions. 

Under  this  heading  are  included  numerous  joint  inflammations  of 
septic  origin,  such  as  occur  in  septicemia,  scarlet  fever  and  diphtheria. 

Arthritis  deformans,  chronic  rheumatic  arthritis,  osteo  arthritis, 
rheumatic  gout,  all  can  be  classed  as  one  subject. 

Definition. — A  deforming  disease  of  the  joints  regarded  by  au- 
thorities as  distinct  from  gout  and  rheumatism.  They  are  charac- 
terized by  destructive  changes  in  the  synovial  membranes,  cartilages 
and  bone,  and  by  bony  outgrowths  restricting  the  motion  of  the  bone. 

Incipient  cases  of  arthritis  sometimes  closely  resemble  the  mild 
forms  of  acute  rheumatism,  although  its  independence  of  rheumatism 
and  gout  and  their  causes  is  generally  conceded. 

Heredity  plays  a  likely,  if  not  an  important,  part.  Shock,  worry 
and  grief  have  a  closer  relation.  Females  are  more  susceptible  to  the 
disease  than  males,  especially  sterile  women,  and  those  who  have  had 
uterine  or  ovarian  disease.  It  usually  begins  between  the  ages  of 
twenty  and  thirty.  It  may  also  occur  in  children  under  twelve  and 
as  late  as  fifty. 

A  slight  injury  or  sprain  or  strain  occurring  in  a  weakly  child  or 
one  convalescent  from  a  disease  such  as  measles  or  scarlet  fever  may 
result  in  arthritis. 

The  three  structures  which  enter  into  the  formation  of  the  joint 
are  all  affected,  but  the  changes  probably  begin  in  the  cartilages. 

These  changes  which  take  place  consist  of  a  proliferation  of  the 


238  THE    HUMAN    FOOT 

cartilage  cells,  succeeded  by  fibrillation  of  the  entire  cellular  sub- 
stance, which  subsequently  undergoes  mucous  degeneration  and  ab- 
sorption. The  bone  ends  are  laid  bare,  which  subsequently  become 
atrophied,  smooth  and  eburnated.  The  bone  ends  and  cavities  are 
alike  distorted;  concavities  may  become  convexities. 

The  edges  of  the  cartilages,  where  overlapped  by  the  Synovial 
membranes,  thicken  and  form  outgrowths  which  subsequently  ossify 
and  become  the  osteophytes  which  contribute  to  the  deformity  of  the 
bone.  The  effect  of  the  latter  impairs  motion  without  producing 
actual  ankylosis  only  in  rare  instances,  which  may  also  include  the 
vertebrae. 

The  Synovial  membranes  also  become  thickened  and  the  tissue 
hypertrophied.  Sometimes  effusion  in  the  joints  and  bursae  is  present. 
Fragments  of  cartilage  may  be  attached  to  the  tufts  or,  when  they 
become  detached,  may  lie  loose  in  the  joint. 

A  conspicuous  part  of  the  morbid  changes  is  muscular  atrophy. 

Symptoms. — The  difference  in  symptoms  depends  mainly  upon  the 
grouping  of  these  lesions,  which  are  subdivided  into  clinical  varieties 
as  follows : 

1.  Multiple  arthritis  deformans,  including  Heberden's  nodosities 
and  the  progressive  form,  in  which  large  joints  are  successively  in- 
vaded in  an  acute  or  a  chronic  manner. 

2.  The  monarthritic  or  partial  form,  in  which  one  or  two  joints 
are  alone  attacked. 

3.  The  acute  polyarticular  variety  which  attacks  young  people, 
females  rather  than  males,  and  frequently  following  some  infectious 
trouble  such  as  scarletina,  tonsilitis,  influenza,  etc.  In  these  cases 
the  joints  become  stiff  and  smaller,  and  the  affection  usually  starts 
in  the  fingers  and  toes,  but  spreads  to  other  joints  as  well.  Sometimes 
these  conditions  manifest  themselves  with  gout  and  rheumatism. 

GONORRHEAL  INFECTION  OF  THE  FOOT 

After  the  knee,  the  foot  is  the  most  frequently  involved  in  this  form 
of  arthritis.  It  is  the  common  opinion  that  men  are  more  often  at- 
tacked than  women.     It  usually  appears  after  the  first  week  of  in- 


OTHER   JOINT    AFFECTIONS  239 

fection,  but  it  may  taKe  place  at  any  stage  of  the  disease.  The  milder 
cases  may  endure  only  a  few  weeks,  and  may  be  caused  by  the  irrita- 
tion of  bacterial  products. 

The  disease  presents  itself  in  various  ways.  It  may  include  several 
joints,  coming  on  with  symptoms  resembling  those  attending  an  attack 
of  acute  articular  rheumatism  ;  on  the  other  hand  it  may  attack  only 
one  foot  and  cause  but  slight  constitutional  disturbance.  The  Synovial 
membranes  may  be  attacked  causing  an  exudation  of  fibrin  which,  if 
not  allayed,  may  form  bands  of  adhesions  interfering  with  joint  move- 
ment, eventually  eroding  the  cartilage  and  resulting  in  complete  anky- 
losis. The  periarticular  structures  may  also  be  involved,  producing  a 
pronounced  swollen  area,  with  marked  tenosynovitis,  heat  and  redness. 
Inflammation  is  frequently  absent  although  the  swelling  is  pro- 
nounced, and  abscess  formations  only  appear  when  a  mixed  infection 
is  present.  Not  infrequently  are  the  Plantar  Fascia  and  the  Bursae, 
between  the  Tendo-Achillis  and  the  Os  Calcis,  also  involved  beneath 
the  posterior  tubercle  of  the  Os  Calcis.  As  in  articular  rheumatism, 
the  pain  may  be  very  severe,  but  rest  and  immobilization  are  more 
effective. 

In  flat-foot  cases  where  the  usual  method  of  treatment  is  ineffec- 
tive, it  is  well  to  inquire  into  the  history  of  the  patient  to  learn  of 
a  possibility  of  gonorrheal  infection  or  gonorrheal  arthritis,  which 
require  internal  treatment. 


CHAPTER  XXXI 


DISEASES  AFFECTING  THE  FEET 

Infantile  Paralysis. — After  an  attack  of  anterior  poliomyelitis  the 
remaining  paralysis  more  frequently  affects  those  muscles  which  con- 
trol the  foot  than  any  other  group,  the  Tibialis  Anticus  being  the 
one  more  often  left  in  a  paralyzed  condition.  The  exact  limit  of 
time  after  an  attack  of  this  disease,  when  improvement  may  be  ex- 
pected from  resuscitation  of  the  cells  in  the  Anterior  Cornua,  is 
very  uncertain.  It  may  be  six  months  and  probably  longer.  After 
the  nerve,  cells  have  entirely  recovered,  due  to  stretching,  atrophy 
and  degeneration  of  the  muscles,  paralysis  may  still  remain.  Very 
little  is  known  of  the  true  causes  of  infantile  paralysis.  The  disease 
is  usually  limited  to  the  time  of  the  first  dentition  in  children. 
It  may  be  due  to  exposure,  to  severe  heat  and  sunstroke  or  of 
traumatic  origin,  and  also  has  been  known  to  occur  during  or 
soon  after  measles,  scarlet  fever,  typhoid  fever,  pneumonia  and 
erysipelas.  The  disease  may  attack  healthy  and  unhealthy  children, 
boys  and  girls  alike,  without  any  apparent  cause.  Paralysis  is  more 
common  in  children,  and  usually  develops  during  the  night  rather  than 
the  day,  and  commonly  during  the  hot  months.  Some  regard  the 
affection  as  infectious  in  origin,  although  this  has  not  been  definitely 
demonstrated. 

Diagnosis  is  not  difficult  in  typical  cases,  but  in  others  the 
recognition  of  the  disease  is  exceedingly  difficult,  and  in  the  initial 
stage  it  is  never  easy  to  establish  a  positive  diagnosis.  The  occur- 
rence of  localized  pain  at  this  time  may  present  a  misleading  symp- 
tom, and  sensitiveness  .of  the  affected  limbs  may  lead  one  to  be- 
lieve that  it  is  rheumatism.  Due  to  a  weakened  condition  of  the 
tendons  no  visual  movement  is  demonstrated,  but  if  a  finger  is  placed 
on  it  contraction  may  be  felt. 

240 


DISEASES    AFFECTING    THE    FEET  241 

Treatment  consists  in  fitting  accurate  appliances  to  support  and 
protect  the  paralyzed  limb.  In  those  cases  in  which  there  is  only  a 
slight  eversion  of  the  foot,  with  a  small  degree  of  valgus,  an  arch  sup- 
port such  as  is  used  in  flat-foot  will  answer  the  purpose  in  correcting 
the  deformity. 

MYASTHENIA    (Intermittent    Limping) 

Is  a  condition  which  is  severe.   Spontaneous  cramp-like  pain  occurs 

in  the  calf  of  the  leg  while  walking.  If  the  limbs  are  rested  for  a  mo- 
ment the  pain  is  relieved,  the  attack  returning  when  walking  is  re- 
sumed. Due  to  circulatory  disturbance  there  is  a  feeling  of  coldness  in 
the  foot,  accompanied  by  a  blanching  of  the  skin.  In  two  cases  re- 
ported by  Lovett  there  was  an  absence  of  pulse  in  the  Dorsalis  Pedis 
and  in  the  Posterior  Tibial  arteries.  If  syphilis,  diabetes  or  chronic 
alcoholism  exists  specific  systemic  treatment  may  relieve  the  local 
condition. 

SYPHILIS 

Although  this  disease  is  widely  prevalent,  it  is  remarkable  that  in 
our  large  orthopedic  clinics  the  number  of  syphilitic  bone  and  joint 
diseases  treated  are  limited.  Usually  the  syphilitic  baby  is  a  puny, 
wrinkled  specimen,  bearing  certain  indications  of  the  disease.  Babies 
affected  thus  present  little  difficulty  in  diagnosis,  but  it  should  be 
remembered  that  some  who  later  develop  characteristic  lesions  are 
perfectly  normal  in  appearance  when  born.  In  infants  hereditary  bone 
syphilis  often  takes  the  form  of  an  osteochondritis  of  an  epiphysis,  ac- 
companied by  pain,  swelling  and  at  times'  effusion.  The  knee  and 
elbow  are  more  vulnerable  and  the  affection  is  frequently  polyarticular. 

This  process,  if  left  unchecked,  may  result  in  local  destruction  or 
epiphyseal  separation.  Persistent  unilateral  or  bilateral  hydrops  of 
the  knee,  which  is  a  tardy  manifestation  of  hereditary  lues,  is  seen  in 
older  children,  but  may  clear  up  on  mixed  treatment.     This  condition 

16 


242  THE    HUMAN    FOOT 

may  also  be  due  to  chronic  tubercular  synovitis,  but  does  not  yield 
to  specific  treatment.  Hereditary  or  acquired  bone  lesions  may  be 
due  to  an  osteo  periostitis,  with  pain,  tenderness  and  overgrowth  of 
bone  in  thickness  and  length,  or  to  gummata,  involving  bones  and 
joints.  The  elongated  saberlike  Tibia,  the  result  of  chronic  specific 
osteo  periostitis,  is  occasionally  seen  in  children,  with  multiple  bone 
swellings  of  unmistakable  significance,  usually  near  the  joints. 

RAYNAUD'S    DISEASE 

Is  a  nervous  disease  which  affects  vasmotion.  It  may  affect  any 
of  the  extremities  or  other  parts  of  the  body. 

There  are  three  stages,  the  first  being  marked  by  attacks  of  cold 
and  emotional  excitement  (local  syncope),  and  the  second  stage 
by  capillary  congestion  and  livid  swelling  (local  asphyxia),  also  blue- 
ness  of  the  skin    (local  cyanosis). 

The  third  state,  which  is  that  of  gangrene,  may  eventually  result 
with  mummification  of  the  part. 

In  the  first  stage  or  that  of  syncope,  due  to  failure  of  the  heart's 
action,  the  parts,  usually  the  Plantar  surface  of  the  toes,  become 
white  and  cold,  attended  with  pain,  which  at  times  is  not  severe 
while  at  others  excruciating.  It  may  be  caused  by  exposure  to  a 
low  temperature,  not  necessarily  a  very  cold  one,  or  by  standing  or 
walking. 

Rest  and  warmth  may  restore  the  part  to  its  normal  condition, 
and  the  disease  manifest  only  the  symptoms  of  the  first  stage,  prob- 
ably not  progressing  to  the  second.  The  disease  may  be  arrested  at 
any  time,  not  returning  for  months  or  years. 

In  the  second  stage,  which  usually  follows  the  first,  that  of  local 
asphyxia  (suspended  animation  from  suffocation  or  a  deficiency  of 
oxygen  in  the  blood),  the  parts  become  blue  or  purple  with  livid  swell- 
ing.    As  in  the  first  stage  the  pain  varies. 

The  third  stage  does  not  always  follow.  When  this  condition  is 
recognized  the  patient  should  be  referred  to  a  physician. 


DISEASES    AFFECTING   THE    FEET  243 

RICKETS 

Believing  that  the  various  bone  deformities  are  the  result  of 
rickets,  a  definition  of  this  condition  is  indispensable  to  clearly  under- 
stand these  various  diseases  as  affecting  the  feet. 

Rachitis,  or  rickets,  is  a  constitutional  disease  which  affects  young 
children,  marked  by  an  increase  of  cell  growth  of  the  bones.  Its  chief 
characteristics  are  manifested  in  the  Osseous  system,  a  local  or  general 
disturbance  of  the  normal  process  of  ossification  being  the  result,  The 
Epiphysis  (a  process  of  bone  attached  to  another  by  cartilage  which 
later  ossifies)  becomes  enlarged  and  the  bone  affected  becomes  soft 
and  pliable.  Their  growth  is  delayed  and  deformities  of  a  serious 
nature  arise.  The  disease  is  one  of  malnutrition  appearing  in  children 
within  the  first  three  years  of  life,  though  it  may  appear  later.  It  is 
induced  principally  by  giving  the  child  insufficient  food  or  the  wrong 
balance  of  foods;  also  by  the  want  of  air,  sunlight  and  cleanliness. 

Treatment. — The  most  essential  is  to  correct  the  hygiene  and  build 
up  by  good  diet.  When  the  feet  and  legs  are  affected  splints  and 
proper  braces  should  be  applied. 

VARICOSE  VEINS 

Varicose  veins  and  varicose  ulcers  of  the  leg  are  not  strictly 
orthopedic,  but  as  they  are  both  common  and  troublesome  it  would 
be  well  to  acquaint  you  with  a  simple  mode  of  treatment  which  has 
often  proved  efficacious. 

Varicose  veins,  or  varix,  is  a  condition  where  the  vein  has  become 
permanently  lengthened  and  dilated.  The  superficial  veins  of  the 
legs,  especially  the  internal  and  external  Saphenous  veins,  are  the 
most  liable  to  become  affected.  Anything  that  will  lead  to  continued 
distension  of  the  vein,  such  as  prolonged  standing,  weight  lifting, 
severe  exertion,  etc.,  that  throws  a  heavy  strain  on  the  walls  and 
valve  of  the  veins,  will  cause  the  condition.  Other  causes  are  tight 
clothing,  such  as  garters,  corsets  and  active  causes  as  pregnancy, 
organic  heart  and  lung  diseases. 

Treatment. — First  remove  as  much  exertion  on  the  veins  as  pos- 


244  THE    HUMAN    FOOT 

sible.  Fit  the  patient  to  foot-eazers,  arched  high  to  distribute  the 
weight,  and  look  into  the  matter  of  correct  shoes.  Then  the  veins 
may  be  supported  by  strapping,  bandaging  or  elastic  stockings,  the 
latter  affording  the  most  relief  to  the  patient.  Varicose  veins  and 
ulcers  can  only  be  cured  by  extirpation.  Under  the  conventional 
mode  of  treatment  varicose  ulcers  are  difficult  to  heal  while  the 
patient  is  active,  but  under  zinc  oxide  adhesive  plaster  strapping  they 
heal  readily.  The  ulcer  is  covered  and  its  edges  drawn  together  by 
overlapping  strips  of  one  inch  wide  zinc  oxide  adhesive  plaster  nearly 
encircling  the  leg.  This  dressing  is  to  be  renewed  every  other  day, 
no  other  treatment  being  required. 

ANKYLOSIS 

By  ankylosis  is  meant  a  condition  of  immobility  resulting  from 
some  inflammation  or  injury  to  the  articular  structure  or  joint. 

Ankylosis  is  derived  from  a  Greek  word,  meaning  crooked  or 
hooked,  and  is  a  term  used  to  designate  immobility,  stiffness  or  con- 
solidation of  a  joint,  whether  in  a  straight  or  crooked  position.  It 
may  be  either  true,  osseous,  complete,  false,  fibrous  or  incomplete. 
When  the  state  of  a  joint  is  fixed  and  absolutely  motionless  the 
ankylosis  is  said  to  be  true  or  complete,  and  is  known  as  false, 
fibrous  or  incomplete  ankylosis  when  the  motion  of  the  joint  is  limited. 
Ankylosis  more  frequently  affects  the  Ginglymoid  (a  joint  resembling 
a  hinge)  articulations,  but  it  may  occur  in  any  kind  of  joint.  Usually 
only  one  joint  is  ankylosed  in  the  same  individual,  but  others  may 
be  affected  at  the  same  time. 

Treatment. — Treatment  depends  greatly  upon  the  condition  found. 
In  simple  or  incomplete  ankylosis,  where  adhesions  are  not  of  much 
density,  massage,  manipulations  and  exercising  the  parts  will  restore 
mobility.  In  the  more  severe  cases  more  vigorous  methods  and  surg- 
ery must  be  resorted  to  to  separate  the  joint. 


CHAPTER    XXXII 


DISEASES   OF  THE   FEET 


VERRUCA    OR   WART 

Verruca,  or  wart,  is  a  clearly  defined  epidermal  growi'h,  ranging 
in  size  from  a  pinhead  to  the  size  o-f  a  pea  or  larger.  It  may  be  hard 
or  soft. 

There  are  many  varieties  of  verruca  and  they  are  known  by  the 
form  of  their  development. 

Verruca  Vulgaris  is  the  wart  which  is  usually  seen  upon  the  hands, 
individually  or  in  numbers.  It  is  a  round,  firm,  clearly  defined  eleva- 
tion with  a  broad  base,  and  may  have  a  smooth  or  roughened  surface 
due  to  hypertrophy  of  the  Papillae.  Their  color  is  usually  of  a  dark 
brown  and  of  slow  growth. 

Verruca  Plana  (verruca  senilis;  verruca  seborrhceica ;  keratosis 
pigmentosa)  is  a  flat  wart  which  develops  upon  the  face,  trunk  and 
extremities,  chiefly  of  people  advanced  in  age.  It  is  dark  of  color, 
flat,  usually  covered  by  greasy  scales  and  ranges  in  size  from  a  pea 
+o  a  finger  nail.  Under  the  epidermal  covering  a  slightly  bleeding 
and  granulated  surface  is  seen.  These  warts,  particularly  those  highly 
pigmented,  may  give  rise  to  skin  cancer. 

Verruca  Filiformis,  as  its  name  implies,  is  a  thread-like  growth, 
is  soft  and  covered  with  a  smooth  skin.  This  form  of  wart  is  most 
frequently  seen  on  the  neck  and  eyelids. 

Verruca  Acuminata  (venereal  wart;  condyloma  acuminatum)  is 
usually  found  on  or  near  the  anus  or  genitals  of  both  sexes,  and  in 
most  cases  of  venereal  origin.  The  lesions  may  be  few  or  numerous, 
of  various  sizes  and  shapes,  pointed  and  of  a  pinkish,  reddish  color. 
Where  they  appear  on  the  cutaneous  surfaces  they  are  dry  and  firm, 
but  on  the  mucous  surfaces  soft  and  moist,  at  times  becoming  purulent 

245 


246 


THE    HUMAN    FOOT 


with  an  offensive  penetrating  odor.  The  actual  causes  of  verruca  are 
obscure,  but  the  acuminate  form  is  probably  due  to  irritating  dis- 
charges, particularly  those  of  gonorrhea. 

AYarts  generally  occur  in  early  adult  life  and  may  be  contagious. 
Local  treatment  consists  in  removing  the  warts  by  excision,  the  use 
of  caustics  or  electrolysis. 

SUPERNUMERARY    TOES    (POLYDACTYLISM) 

Is  a  deformity  in  which  more  than  five  fingers  or  toes  are  present, 
and  is  a  source  of  mortification,  sometimes  producing  mental  agita- 
tion which  is  often  the  cause  of  alarming  nervous  symptoms.  There 
are  several  classes  but  all  of  congenital  origin.  Records  show  that 
there  have  been  cases  where  ten  and  as  many  as  thirteen  toes  were 
found   on  one  foot.     Some  were  fully  formed  but  more  often  were 


Chart  No.  164 
Supernumerary  Toes 


imperfect  and  associated  with  some  other  deformity.  This  deformity 
should  be  corrected  when  the  child  is  still  young,  as  growth  ob- 
literates many  of  their  effects.  The  removal  of  the  supernumerary 
toes  can  be  accomplished  with  perfect  safety  at  two  or  three  months 
after  birth. 

WEBBED    FINGERS    AND    TOES 

As  a  rule  this  condition  is  congenital,  but  it  may  arise  from  burns 
or  inflammation.  The  fingers  in  this  condition  are  firmly  held  together 
by  strong  tegumentary  adhesions.  Surgical  operation  is  necessary 
to  correct  the   deformity. 


DISEASES    OF    THE    FEET  247 

PERFORATING  ULCER  OF  THE  FOOT 

Perforating  ulcer  of  the  foot  usually  occurs  on  the  sole  of  the 
foot  in  the  Metatarsal  region,  is  painless  and  shows  no  tendency  to 
heal.  Other  indications  of  the  nervous  condition  underlying  the  ulcer 
may  be  found  in  the  other  parts  of  the  body,  such  as  the  condition 
of  the  skin  and  nails  of  the  hand,  or  may  be  associated  with  peripheral 
neuritis  or  with  the  central  lesion.  The  ulcer,  due  to  its  absence  of 
pain,  is  usually  neglected,  and  is  about  an  eighth  to  a  quarter  of  an 
inch  in  diameter  before  treatment  is  applied,  sometimes  reaching  to 
and  involving  the  bone.  It  is  frequently  caused  by  trimming  away 
an  original  growth  of  callous  which  has  become  infected  by  the 
use  of  a  knife  or  scissors,  which  develops  a  small  ulcer  underneath 
the  deeper  layer  of  skin  and  finally  breaks  through;  hence  its  name, 
perforating  ulcer.  The  callous  formation  about  the  ulcer  often  leads 
one  to  believe  that  it  is  an  infected  corn. 

Treatment. — The  true  cause  should  be  learned  and  proper  treat- 
ment applied.  The  wound  should  be  thoroughly  cleansed,  then  lightly 
packed  and  dressed.  Pressure  should  be  removed  from  the  surround- 
ing area,  which  can  be  accomplished  by  wearing  an  arch  support  or 
foot-eazer. 

CHILBLAINS    (PERNIO) 

Chilblains  (Pernio)  are  usually  due  to  poor  circulation,  which 
causes  congestion  of  the  tissues  of  the  skin,  giving  rise  to  swelling 
and  redness.  Chilblains  are  produced  by  long  exposure  to  cold.  The 
skin  assumes  a  purplish  color  and  accumulation  of  serum  in  the  cellular 
tissues  accompanied  by  burning  pain  and  itching.  Anemia  is  a  pre- 
disposing factor  in  chilblains. 

Treatment. — Comfortable  shoes  should  be  fitted,  and  wide  stock- 
ings of  cotton  should  be  substituted  for  woolen  ones,  or  vice  versa. 
The  chilblain  lotion,  applied  locally,  often  proves  very  useful  in 
affording  relief  to  the  itching,  burning  and  swelling,  but  proper  foot 
gear  is  important  and  beneficial.  Standing  or  sitting  with  feet  on 
hard,  cold  floors  is  very  harmful.    Apply  ointments  containing  tannic 


248  THE    HUMAN    FOOT 

acid  or  apply  chilblain  lotion  to  the  parts,  let  dry  and  then  bandage 
with  soft  gauze. 

FROST    BITE 

Congelation  and  Frost  Bite. — This  condition  is  produced  by  long 
exposure  to  severe  cold.  As  a  rule  the  frost  bite  occurs  very  slowly 
and  the  first  symptom  is  felt  by  the  numbness  and.  lack  of  feel- 
ing in  the  parts.  In  the  usual  frost  bite  the  action  of  the  cold  has 
been  sufficient  to  shut  off  the  circulation  until  some  of  the  tissues 
have  died.  The  feet  should  then  be  thawed  out  slowly  by  rubbing 
with  snow.     Diagnosis   is  not   difficult. 

Treatment  consists  in  restoring  gradual  circulation  by  massage 
with  cold  applications.  Care  should  be  taken  not  to  induce  a  sudden 
rising  of  temperature,  as  it  may  result  in  a  paralysis  of  the  muscular 
coats.  The  foot  should  be  kept  moist  one  or  two  days,  then  dried 
and  powdered  with  boric  acid  and  wrapped  in  wool  and  placed  in 
an  elevated  position.  If  gangrene  sets  in  a  physician  should  be 
called. 

HYPERIDROSIS   OR  EXCESSIVE  PERSPIRATION 

Hyperidrosis,  Excessive  Sweating,  is  a  condition  which  attacks 
the  feet  and  causes  an  excessive  exudation  of  sweat  and  has  a  pungent 
and  penetrating  odor,  which  is  very  disagreeable  and  sometimes 
annoying. 

This  disease  is  very  common,  especially  in  summer,  among  a  large 
percentage,  while  in  others  it  is  found  most  prevalent  in  cold  weather. 
The  feet  are  always  moist,  which  makes  the  hosiery  damp  and  wet, 
affecting  the  wear  of  the  shoes.  It  is  not  at  all  infrequent  to  find 
shoes  that  have  rotted  through  due  to  this  excessive  sweating.  There 
are  various  causes,  but  anything  that  depresses  the  nervous  tone 
will  sometimes  give  rise  to  the   cause. 

Treatment. — Internal  treatment  is  sometimes  indicated,  but  the 
most  effective  is  to  bathe  the  feet,  using  pedico  granulated  foot  soap 
firmly  rubbed  and  massaged  over  the  feet  to  keep  them  thoroughly 


DISEASES    OF   THE    FEET  249 

clean  and  stimulate  healthy  skin  action.  Then  powder  with  antisep- 
tic foot  powder,  using  all  other  hygienic  precautions,  such  as  change 
of  hosiery  and  shoes. 


ANHIDROSIS   OR  SCANTY  PERSPIRATION 

Anhidrosis. — Scanty  perspiration  with  a  dry  and  burning  skin  is 
more  the  result  of  constitutional  disturbances  than  from  a  local  dis- 
order. Those  persons  affected  with  rheumatism  or  dyspepsia  are 
particularly  liable  to  it  and  suffer  more  or  less,  as  the  stomach  is 
deranged.  The  harsh,  hot  skin  can  be  relieved  by  bathing  the  feet 
in  warm  water,  mixed  with  bran,  and  by  using  pedico  foot  balm, 
massaging  the  feet  thoroughly  at  night,  and  also  by  resting  them 
frequently,  especially  after  walking,  but  more  good  can  be  derived 
from  the  restoration  of  health.  Thus  the  patient  should  be  referred 
to  a  physician. 

BROMIDROSIS    OR    FETID    PERSPIRATION 

Bromidrosis. — The  functional  disease  of  the  sweat  glands  of  the 
feet,  which  is  present,  is  thought  to  be  of  nervous  origin  but  the 
fetid  perspiration  is  due  to  bacterial  growths.  The  feet  have  a  very 
offensive  odor  and  the  disease  is  quite  common  among  both  men 
and  women.  The  actual  secretion  may  be  normal,  yet  of  an  un- 
healthy quality. 

Treatment. — Absolute  cleanliness  is  the  first  essential.  This  is 
accomplished  by  using  pedico  granulated  foot  soap,  rubbing  and 
massaging  to  thoroughly  cleanse  the  skin,  then  bathing  the  feet  in  an 
antiseptic  lotion  of  footdok  tablets,  after  which  they  should  be  dried 
and  antiseptic  foot  powder  applied.  Shoes  and  stockings  should  be 
changed   frequently. 

Bathing  the  feet  alternately  in  hot  and  cold  water  or  in  a  solu- 
tion of  tannic  acid  and  borax  will  often  prove  beneficial;  change  of 
stockings  is  also  recommended. 


250  THE    HUMAN    FOOT 

ECZEMA 

Eczema. — Eczema  is  an  inflammatory  skin  disease  with  vesicula- 
tion,  infiltration,  watery  discharge  and  the  development  of  scales  and 
crusts.  It  may  be  an  acute,  sub-acute  or  chronic  multiform  disease. 
The  lesions  vary  considerably  in  character  and  the  disease  is  usually 
attended  with  fever,  restlessness,  itching  and  burning  as  well  as 
other  symptoms  of  constitutional  disturbances. 

Eczema  is  a  catarrhal  inflammation  of  the  skin,  and  the  itching 
probably  is  due  to  the  involvement  of  cutaneous  nerves.  It  is  not 
contagious  or  hereditary,  although  in  some  cases  there  is  an  hereditary 
predisposition  handed  down  from  parent  to  child,  also  some  persons 
are  more  susceptible  to  the  disease  than  others.  There  are  many 
different  forms  of  eczema  and  sometimes  they  are  difficult  to  diagnose 
correctly. 

Causes. — The  constitutional  or  predisposing  causes  are  rheumatic 
diathesis,  defective  kidney  elimination,  albuminuria,  anemia,  etc.  The 
most  common  causes  are  dyspepsia,  constipation,  mental  and  physical 
exhaustion ;  neurosis  of  functional  or  organic  origin  are  also  likely 
to  cause  the  disease.  The  local  or  exciting  causes  are  most  numerous. 
Any  external  agency  that  may  produce  a  dermatitis  may  result  in 
eczema.  Heat,  cold,  alkalies,  acids,  excessive  local  use  of  water  and 
other  chemical  substances  are  among  the  most  common  of  the  local 
causes. 

Treatment. — The  parts  should  be  kept  free  from  water  and  soap 
and  all  irritating  properties,  and  a  mild,  healing  ointment  contain- 
ing salicylic  acid  should  be  applied.     A  specialist  should  be  consulted. 

SYPHILIS 

Syphilis,  the  Squamous  or  Papulosquamous  Syphilide,  is  a  popular 
eruption  in  which  scaling  is  a  prominent  feature.  The  scales  are 
of  a  dirty  gray  color,  usually  adherent  and  situated  on  the  apex  of 
the  papules  or  encircling  them  at  the  base.  This  eruption  is  most 
frequently  found  on  the  palms  and  soles,  and  because  of  the  thickness 
of  the  skin  and  firm  attachment  of  the  epidermis   of  these  regions 


DISEASES    OF    THE    FEET  251 

the  papular  feature  may  be  entirely  absent,  the  lesions  representing 
sharp,  clear  defined,  dull  red  spots  covered  or  surrounded  by  epider- 
mal shreds.  Eruptions  on  these  parts  are  very  persistent  and  re- 
bellious to  treatment.  Squamous  syphilo-derm  eruptions  on  the 
Palmar  and  Plantar  surfaces  may  resemble  psoriasis  and  squamous 
eczema  of  these  parts,  but  psoriasis  is  a  more  diffused  disease  with  a 
tendency  to  affect  the  Extensor  surfaces,  usually  the  elbows  and 
knees,  and  never  affects  the  palms  and  soles  exclusively.  Squamous 
eczema  very  seldom  is  confined  to  the  palms  and  soles,  but  usually 
also  involves  the  backs  of  the  hands  and  feet,  presents  a  more  inflam- 
matory aspect  and  is  more  general  in  distribution,  and  intense  itching 
is  another  characteristic.  In  syphilis  the  lesions  are  deeper  seated, 
darker  in  color,  usually  of  a  ham  or  copper  hue,  and  usually  itching 
is  absent. 

PLANTAR    NEURALGIA 

Erythromelalgia,  Plantar  Neuralgia,  is  a  chronic  disease  in  which 
there  is  a  painful  congestion  of  the  feet.  Usually  the  pain  first  limits 
itself  to  the  heel  or  to  the  fore  foot  and  occurs  only  at  night  but 
eventually  extending  over  the  entire  Plantar  surface,  being  present 
both  night  and  day.    In  this  stage  walking  or  standing  is  very  painful. 

Dana  construes  this  a  form  of  Plantar  neuralgia,  and  that  in  rare 
cases  the  pain  of  sciatica  is  limited  to  the  Plantar  nerves  and  is  accom- 
panied by  an  anesthesia  and  paresthesia  of  this  region. 

OSTEOMA 

Osteoma. — Any  bone  may  be  the  seat  of  an  osteoma.  These 
are  found  in  the  lower  extremities,  the  Femur  or  Tibia  or  on  the 
Dorsal  surface  of  the  Phalanx  of  the  great  toe.  It  lifts  the  nail 
upward  by  the  tumorous  growth.  Surgical  operation  is  a  very 
simple  way  to  correct  this  condition. 


252  THE    HUMAN    FOOT 

BLISTER 

Blister. — Blisters  may  develop  on  the  feet  due  to  ill-fitting  shoes 
or  from  a  rough  seam  with  unaccustomed  exercising.  They  may 
contain  clear  or  bloody  serum.  Absolute  cleanliness  is  essential 
to  prevent  infection. 

Treatment. — Apply  a  moist  dressing  of  boracic  acid  or  a  heal- 
ing cold  cream  until  the  soreness  disappears.  Then  apply  alcohol 
to  harden  the  skin  tissue  and  a  zin-ox  pad  to  prevent  recurrence. 


CHAPTER    XXXIII 


FRACTURES  AFFECTING  THE  FEET 

A  fracture,  in  the  surgical  sense  of  the  term,  is  meant  the  breaking 
of  a  bone  or  cartilage.  The  liability  to  fracture  of  the  different  bones 
of  the  body  varies  greatly,  depending  on  their  difference  in  size,  shape 
and  degree  of  exposure  to  external  violence  or  extreme  muscular 
action.  Fractures  are  more  numerous  in  men  than  in  women  in  the 
proportion  of  approximately  three  to  one,  it  varying  greatly  at  dif- 
ferent ages.  In  infancy  the  difference  is  insignificant,  but  in  middle 
life  fractures  are  ten  times  as  frequent  in  men  as  in  women;  between 
the  ages  of  fifty  and  seventy  years  the  differences  again  become  slight. 
After  seventy  years  of  age  fractures  are  more  common  in  women 
than  in  men.  Due  to  the  disproportionate  increase  in  the  number  of 
fractures  of  the  neck  of  the  Femur,  we  have  a  reversal  of  conditions. 

There  are  numerous  varieties  of  fractures  which  are  constituted 
by  differences  in  the  extent  of  the  injury  to  the  bone  or  to  the  sur- 
rounding soft  parts  in  the  seat,  shape  and  direction  of  the  fracture,  in 
the  relation  of  the  fragments  to  each  other,  and  in  the  number  of  bones 
involved.  These  varieties  may  be  grouped  into  five  divisions,  and 
many  subdivisions,  marked  by  important  clinical  differences,  as 
follows : 

1.  Incomplete  fractures. 

(a)  Fissures. 

(b)  True  incomplete,  "green  stick" ;  bent  bone. 

(c)  Depressions. 

(d)  Separation  of  a  splinter  or  of  an  epiphysis  (long  pro- 

tuberance or  outgrowth). 

2.  Complete  fractures,  subdivided  according  to 

(a)  Direction  and  character  of  the  line  of  fracture  into 
transverse,  oblique,  longitudinal,  spiral,  toothed  or 
dentate,  V,  Y  or  T-shaped,  and  comminuted  (broken 
up). 

253 


254  THE    HUMAN    FOOT 

(b)  Seat  of  the  fracture,  into  fracture  of  the  shaft,  of  the 

neck,  of  the  upper,  middle  or  lower  third  intercon- 
dyloid,   separation  of  epiphysis;  and 

(c)  If  extending  into  a  joint  intra-articular. 

3.  Multiple  fractures,  comprising  fractures  of  two  or  more  non- 

adjacent  bones  and  two  or  more  fractures  of  the  same  bone. 

4.  Compound  fractures. 

5.  Gunshot  fractures. 

The  term  simple  fracture  is  used  in  contra-distinction  to  the  term 
compound  fracture,  and  is  a  fracture  without  any  rupture  of  the  over- 
lying skin.  Spontaneous  fracture  is  one  due  to  slight  force,  as  when 
there  is  disease. 

Ununited  fracture,  one  in  which  a  union  of  the  bones  has  failed. 

Incomplete  Fractures  are  fractures  in  which  the  continuity  of  the 
bone  has  not  been  completely  lost,  or  a  fragment  has  not  been  com- 
pletely detached. 

Fissures  are  characterized  by  the  existence  of  a  split  or  crack  in 
the  bone,  and  which  does  not  entirely  circumscribe  a  fragment  sepa- 
rating it  from  the  rest  of  the  bone.  In  the  bones  of  the  cranium  it 
is  of  common  occurrence,  and  in  the  long  bones  very  rare,  except  when 
associated  with  other  varieties.  In  the  short  or  spongy  bones  it  is 
almost  unknown.  Fissures  connected  with  complete  fracture  are  com- 
mon, and  sometimes  very  long,  extending  into  a  neighboring  joint. 
These  long  fissures  are  called  a  longitudinal  fracture.  Forcible  bend- 
ing of  a  long  bone  will  probably  produce  a  long  isolated  fissure. 
The  importance  of  a  fissure  is  slight,  except  when  it  extends  into  a 
joint.  In  some  cases  the  injury  has  been  followed  by  suppuration 
beneath  the  periosteum,  or  within  the  bone. 

Incomplete  Fracture,  "Green-Stick  Fracture,"  Bent  Bone. — This 
variety  is  characterized  by  a  fracture  involving  only  a  portion  of  the 
thickness  of  the  long  bone  at  the  seat  of  the  fracture. 

Depressions  are  fractures  in  which  a  portion  of  the  outer  layer  of 
a  flat  bone,  or  the  spongy  portion  of  a  long  bone,  has  been  driven 
inward  by  direct  violence,  usually  a  blow  with  a  pointed  instrument. 
This  injury  is  most  frequently  seen  in  the  vault  of  the  skull,  being 


FRACTURES    AFFECTING    THE    FEET  255 

termed  a  fracture  of  the  outer  table.  Occasionally  it  is  seen  in  the 
limbs  in  connection  with  a  complete  fracture. 

Separation  of  a  Splinter  of  an  Epiphysis. — Two  classes  of  fractures 
are  included  in  this  variety  which  differ  widely  in  their  mode  of  pro- 
duction, but  have  this  in  common :  that  the  fragment  does  not  com- 
prise the  entire  breadth  or  thickness  of  the  bone,  and  that  consequently 
the  continuity  of  the  latter  is  not  destroyed. 

In  the  first  class,  a  splinter  or  fragment  of  the  bone  is  broken  off 
by  direct  violence,  and  in  the  second  class  a  long  prominence  is  torn 
off  by  the  violent  contraction  of  the  muscle  attached  to  it,  or  by  trac- 
tion through  a  ligament. 

Complete  Fractures. — By  a  complete  fracture,  when  applied  to  a 
long  bone,  is  meant  the  division  into  two  or  more  fragments  by  a 
line  of  fracture  crossing  its  long  axis. 

Subdivision  According  to  the  Direction  of  the  Line  of  Fracture. — 
Terms  in  use  are  transverse,  oblique,  splintered,  spiral,  V-shaped,  T  or 
Y-shaped,  toothed,  or  dentate,  and  longitudinal.  As  a  result  of 
direct  or  indirect  violence  which  bends  a  long  bone,  the  fracture  is 
either  practically  transverse  or  markedly  oblique,  with  or  without 
splintering. 

Spiral  fractures  are  very  rare,  and  are  produced  by  torsion  of  the 
bone.  They  are  found  in  the  Femur,  Humerus  and  Tibia.  In  the  lat- 
ter they  are  known  as  V-shaped,  and  can  be  readily  recognized  by 
the  sharp  point  of  the  upper  fragment,  which  can  be  felt  midway  be- 
tween the  crest  and  the  internal  border  of  the  bone.  From  the  re- 
entrant angle  corresponding  to  this  point  a  fissure  runs  down  to  the 
ankle  joint. 

Longitudinal  fractures  include  fractures  which  are  very  oblique  and 
run  from  one  side  of  the  bone  to  the  other,  or  from  one  end  of  the  bone 
to,  or  nearly  to,  the  other,  and  fractures  which  split  lengthwise  with 
a  long  fragment  intermediate  between' two  transverse  fractures.  The 
latter  is  produced  by  great  crushing  violence.  In  the  other  forms 
the  violence  is  indirect.  A  bend  or  twist  of  the  bone,  or  a  blow 
received  at  one   end,   is   apparently  the   cause.     The  serious   results 


256  THE    HUMAN    FOOT 

which  usually  follow  are  due,  in  some,  to  the  implication  of  one  or 
both  joints. 

A  comminuted  fracture  is  a  fracture  of  the  shaft  of  a  long  bone,  and 
in  addition  to  the  complete  division  of  the  bone  into  fragments,  there 
is  also  splintering  of  the  portion  of  bone  adjoining  the  fracture,  or  of 
one  of  the  fragments. 

Varieties  Dependent  Upon  the  Seat  of  the  Fracture. — A  fracture 
may  occupy  any  portion  of  the  bone  and  consequently  is  known  by 
its  name.  For  example,  fracture  of  the  neck  of  the  Femur,  of  the 
lower  third  of  the  Tibia,  of  the  head,  of  the  shaft,  of  the  Inner  Condyle, 
of  the  Acromion;  Intercondyloid  fracture,  when  it  passes  across  the 
shaft  and  also  downward  between  the  Condyles;  separation  of  the 
Epiphysis. 

Separation  of  the  Epiphysis. — This  term  applies  to  separation  of 
the  Epiphyses  which  have  not  yet  become  united  by  bone  with  the 
shaft.  Union  of  the  different  bones  takes  place  at  different  ages,  but 
is  ultimately  complete  in  all ;  in  the  female  at  twenty-two  years  of 
age  and  in  the  male  at  twenty-five. 

Intra-Articular  or  Articular  Fractures  are  fractures  in  which  the 
main  line  of  fracture,  or  a  subsidiary  one,  extends  into  a  joint.  Ex- 
amples of  fractures  which  are  common  are  those  of  either  Condyle  of 
the  Femur  or  Humerus,  intercondyloid  fractures  of  the  same  bones, 
fractures  of  the  Patella  and  Olecranon.  The  importance  of  this  va- 
riety arises  partly  from  the  implication  of  the  joint  in  the  inflammatory 
reaction  following  the  trauma,  but  chiefly  from  the  change  in  the 
mechanical  condition  produced  by  the  displacement  of  the  fragment 
and  the  formation  of  adhesions  or  of  callous.  Thus,  the  result  after 
a  fracture  of  the  Patella,  in  which  permanent  displacement  is  slight,  is 
usually  very  good,  while  that  following  a  fracture  of  a  Condyle  of 
the  Humerus  or  of  the  head  of  the  Tibia  may  result  in  great  limita- 
tion of  the  motions  of  the  joint.  In  the  }roung,  excessive  formation 
of  bone  outside  of,  but  near  to,  the  joint  as  the  result  of  the  traumatic 
irritation  of  the  Periosteum  may  also  mechanically  limit  the  motions 
of  the  joint.  An  important  cause  producing  bad  results  is  due  to  the 
difficulty  or  impossibility  of  properly  reducing  the  displacement,  or 


FRACTURES    AFFECTING    THE    FEET  257 

maintaining  the  reduction,  because  of  the  small  size  of  the  fragment 
and  the  lack  of  efficient  means  of  acting  upon  it.  Hemorrhage  into 
the  joint,  inflammation  of  the  Synovial  membrane,  and  adhesions  of  its 
opposing  surfaces,  inflammatory  thickening,  retraction  and  loss  of  plia- 
bility of  the  periarticular  tissues  are  other  causes.  The  inflammatory 
reaction  varies  in  the  degree  of  these  changes. 

Multiple  Fractures  are  fractures  occurring  simultaneously  to  two 
or  more  nonadjacent  bones,  and  two  or  more  fractures  of  the  same 
bones  whose  lines  are  not  continuous  with  one  another.  Multiple 
fractures  of  different  bones  are  usually  caused  by  great  violence  acting 
in  part  directly  against  the  shaft,  such  as  the  fall  of  a  heavy  weight,  or 
by  the  striking  of  the  thigh  with  some  object  when  thrown  from  a 
vehicle  or  the  like. 

Compound  Fractures  are  fractures  with  a  communicating  wound 
of  the  skin.  The  importance  of  this  communication  arises  through  the 
possibility  of  infection  of  the  wound  from  without,  with  all  the  risks 
involved  in  the  consequent  suppuration  of  the  bone  and  the  lacerated 
soft  parts.  Compound  fractures  in  a  large  proportion  are  caused  by 
direct  violence,  and  the  consequent  laceration  of  the  overlying  soft 
parts,  which  is  to  be  considered  a  serious  addition  to  the  fracture. 

As  the  student  of  the  foot  is  mostly  concerned  in  affections  of  the 
lower  limbs,  I  will  describe  the  fractures  with  which  he  will  come  in 
contact.     Fractures  are  only  treated  by  the  surgeon. 

Fracture  of  the  Patella  is  more  frequent  in  men  than  in  women, 
and  in  middle  life  than  in  childhood  or  old  age.  The  cause  may  be 
direct  or  indirect — a  blow  or  fall  upon  the  patella,  the  sudden  vigorous 
contraction  of  the  Quadriceps  Extensor,  or  the  sudden  flexion  of  the 
knee  against  the  opposition  of  the  quadriceps,  or  by  direct  violence. 

The  fracture  is  usually  transverse  or  slightly  oblique,  at  or  just 
below  the  middle  of  the  bone;  sometimes  it  lies  very  near  one  end 
of  the  bone,  especially  the  lower.  Vertical,  comminuted  and  oblique 
fractures  are  due  to  direct  violence,  and  do  not  usually  show  much 
displacement. 

Fracture  of  the  Upper  End  of  the  Tibia  and  Fibula. — Fractures  of 
the  shaft  of  the  Tibia  and  Fibula  constitute  about  one-fourth  of  those 

17 


258  THE    HUMAN    FOOT 

of  the  lower  extremity,  and  about  six  per  cent  of  all  fractures.  The 
usual  seat  of  fracture  is  at  or  near  the  junction  of  the  lower  and  middle 
thirds.  The  Fibula  is  usually  broken  at  a  higher  level  than  the  Tibia 
when  both  bones  are  broken. 

Fractures  of  this  variety  are  very  uncommon  in  childhood,  their 
maximum  of  frequency  being  found  between  the  ages  of  thirty  and 
sixty  years.  These  fractures  are  caused  by  direct  or  indirect  violence, 
in  the  former  such  as  a  blow  received  directly  on  the  part,  the  fall  of 
a  heavy  body,  or  the  kick  of  an  animal ;  in  the  latter  a  fall  from  a  high 
point,  a  twist  of  the  limb,  especially  abduction. 

The  line  of  fracture  may  be  transverse,  oblique  or  longitudinal.  In 
the  latter  case  it  passes  into  the  joint  and  separates  only  a  portion  of 
the  articular  end  from  the  shaft.  The  internal  tuberosity  of  the  Tibia 
may  be  crushed,  with  rupture  of  the  external  lateral  ligament.  Trans- 
verse fractures  caused  by  direct  violence,  such  as  the  fall  of  a  heavy 
body,  the  kick  of  a  horse,  have  been  observed  very  near  the  articular 
edge.  Comminuted  fractures  have  also  been  caused  by  direct  violence 
and  by  falls  upon  the  feet,  the  shaft  penetrating  and  splitting  the  head. 

Oblique  fractures,  the  line  running  into  the  joint  and  separating  the 
whole  or  part  of  either  tuberosity,  appears  to  be  caused  by  abduction 
or  adduction  of  the  leg,  the  fracture  taking  place  on  the  side  the  leg 
is  bent. 

Due  to  the  proximity  of  the  joint,  and  the  possibility  of  inflamma- 
tory complications,  with  more  or  less  complete  loss  of  the  functions 
of  the  knee  which  that  and  the  derangement  of  the  articular  surface 
in  oblique' and  comminuted  fractures  involve,  make  the  prognoses 
very  serious,  and  also  the  long  period  necessary  for  consolidation. 

Fractures  of  the  Lower  End  of  the  Leg. — In  this  group  are  in- 
cluded the  fractures  of  both  bones  of  the  leg,  in  which  the  lower  end 
of  the  Tibia  is  crushed  or  splintered,  separation  of  the  epiphysis  of 
the  Tibia,  and  the  allied  supermalleolar  fracture.  Fractures  of  both 
bones  at  or  near  the  joint  caused  by  forcible  eversion  of  the  foot  at 
times  aided  by  the  weight  of  the  body,  the  most  common  being 
known  as  Pott's  fractures,  are  very  numerous  and  varied.     The  ac- 


FRACTURES    AFFECTING    THE    FEET 


259 


tion  of  the  causative  violence  through  the  foot  is  a  feature  which  they 
all  have  in  common. 

Fractures  by  Eversion  and  Abduction  of  the  Foot  (Pott's  Frac- 
ture).— Pott's  fracture  is  a  very  common  injury  and  of  especial  im- 
portance because  of  the  great  disability  which  results.  The  lesions 
vary  much  in  extent  and  detail.  Occasionally  fracture  is  entirely 
absent,  and  some  forms  have  been  classed  with  dislocations.  The 
cause  is. a  twist  of  the  foot,  eversion  and  abduction,  and  by  the  weight 
of  the  body.  The  lesions  take  one  or  the  other  of  two  distinguish- 
able  forms,  according  to  the   eversion   or  the  abduction  which   pre- 


Chart  No.  165 
Pott's  Fracture. 

dominates.  If  eversion  is  the  only  or  main  movement,  the  force  is 
exerted  through  the  internal  lateral  ligament,  breaking  the  Internal 
Malleolus  squarely  off  at  its  base  and  pressing  the  External  Malleolus 
outward,  rupturing  the  Tibio-Fibular  ligament,  and  breaking  the 
Fibula  close  above  the  Malleolus.  At  times  instead  of  pure  rupture 
of  the  Tibio-Fibular  ligament  there  is  a  wrenching  of  the  portion  of 
the  Tibia  to  which  it  is  attached  in  front,  behind,  or  both. 

On  the  other  hand,  if  abduction  of  the  front  part  of  the  foot  is 
the  sole  or  chief  movement,  the  first  and  last  of  these  three  lesions 
vary.     Instead  of  a  square  break  at  the  base  of  the  Internal  Malleolus 


260 


THE    HUMAN    FOOT 


there  is  an  oblique,  almost  marginal  fracture  of  its  anterior  por- 
tion or,  more  frequently,  a  rupture  of  the  anterior  portion  of  the 
internal  lateral  ligament.  With  continued  movement  the  torsion  of 
the  Fibula  produces  an  oblique  fracture,  the  upper  end  being  found 
three  or  four  inches  above  the  tip  of  the  Malleolus. 

Symptoms. — Diagnosis  is  readily  made  at  a  glance,  the  appearance 
of  the  region  being  so  characteristic.  The  characteristic  features  are 
outward  displacement  of  the  foot,  with  a  corresponding  prominence 
of  the  Internal  Malleolus  or  the  adjoining  portion  of  the  Tibia.     In 


Chart  No.  166 
Showing  Manner  in  Which  Test  is  Made  for  Mobility  of  Pott's  Fracture. 


marked  cases  backward  displacement  can  also  plainly  be  seen.  Other 
signs  characteristic  of  this  condition  are  abnormal  lateral  mobility 
at  the  ankle.  On  pressure  these  points  of  tenderness  can  be  felt  by 
the  patient,  one  in  front  of  the  position  of  the  Tibio-Fibular  liga- 
ment, in  the  groove  between  the  Tibia  and  External  Malleolus,  show- 
ing rupture  of  the  ligament ;  one  at  the  base  of  the  Internal  Malleolus, 
marking  the  fracture  of  the  Malleolus  or  the  rupture  of  the  anterior 
portion  of  the  lateral  ligament,  and  the  third  over  the  outer  aspect 


FRACTURES    AFFECTING    THE    FEET  261 

of  the  Fibula,  marking  the  fracture  of  the  Fibula  and  marked  ecchy- 
mosis  beneath  the  External  and  Internal  [Malleolus.  Sometimes  there 
is  an  abnormal  mobility  of  the  two  fragments  which  may  be  recog- 
nized. Pott's  fracture  is  very  frequently  recognized  by  the  student 
of  the  foot  owing  to  its  close  resemblance  to  flat-foot.  In  many  in- 
stances shoes  must  be  especially  built  having  extremely  wide  shanks 
and  low  broad  heels  with  extension  under  inner  border.  Mechanical 
aid  is  of  great  importance,  which  consists  of  special  plates  or  arch 
supports  to  restore  balance  to  weight  carrying  point. 

Fracture  of  the  Fibula. — Fracture  of  the  Fibula  is  by  direct  vio- 
lence, muscular  action  (contraction  of  the  biceps)  or  more  frequently 
by  forcible  adduction  of  the  leg  acting  through  the  external  lateral 
ligament  attached  to  the  head  of  the  Fibula.  Paralysis  of  the  Ex- 
tensor and  Peroneal  muscles,  with  loss  of  sensation  in  that  region 
supplied  by  the  musculo-cutaneous  branch  of  the  Peroneal  nerve  is 
usually  the  result  after  accident. 

Fracture  of  the  Astragalus. — Fractures  of  the  Astragalus  are  com- 
monly the  result  of  falls  from  some  high  point,  the  bone  being  broken 
between  the  Calcaneum  and  the  Tibia.  The  lesion  is  frequently 
associated  with  fracture  of  the  Calcaneum  and  with  dislocation  at 
the  ankle  and  fracture  of  the  Fibula;  in  other  cases  the  force  may  act 
transversely.  The  direction  and  extent  of  the  line  of  fracture  vary 
considerably;  the  division  of  the  bone  may  be  transverse,  longitu- 
dinal, horizontal,  oblique,  or  into  numerous  pieces,  and  the  fragments 
widely  separated  and  dislocated.  When  there  is  no  displacement  or 
external  wound,  diagnosis  is  difficult.  Although  there  is  an  indica- 
tion of  severe  injury  to  the  foot — pain,  swelling  and  inability  to  bear 
the  weight  of  the  body  on  it — the  symptoms  are  not  distinctive. 

Fracture  of  the  Calcaneum. — A  fall  upon  the  foot  from  a  height; 
by  contraction  of  the  muscles  attached  to  the  Tendo-Achillis,  and  by 
forcible  inversion  of  the  sole  of  the  foot,  are  causes  which  may  break 
this  bone.  The  causes  vary  the  extent  and  position  of  the  fracture. 
Thus  in  a  fall  directly  upon  the  sole,  the  bone  is  splintered  or  crushed. 
At  times  the  bone  is  also  split  longitudinally.  Forcible  pressure  on 
the  ball  of  the  foot  may  cause  the  same  result. 


262  THE    HUMAN    FOOT 

Fracture  of  the  Sustentaculum  Tali. — The  causes  of  this  fracture 
are  forcible  inversion  of  the  sole  of  the  foot.  Immediately  there  is 
a  change  in  the  position  of  the  foot  from  inversion  to  eversion  and  a 
consequent  permanent  sinking  of  the  inner  border  of  the  foot  and 
Internal  Malleolus  (valgus).  There  is  a  shortening  of  the  heel  by 
slight  displacement  of  the  Calcaneum  forward.     Pain  and  disability. 

Fractures  of  the  Metatarsal  Bones  are  frequently  the  result  of 
direct  violence,  consequently  often  associated  with  contusion  or  lacer- 
ation of  the  skin,  although  the  fracture  may  not  be  compound.  The 
first  Metatarsal  bone  is  the  one  most  frequently  broken,  the  fifth  the 
next  in  order  of  frequency.  There  is  little  tendency  to  displacement 
except  when  several  bones  are  broken  simultaneously.  The  displace- 
ment is  usually  of  the  broken  end  of  either  fragment  toward  the 
Dorsum  of  the  foot. 

Localized,  abnormal  mobility,  and  grating  of  the  bones  when  the 
first  or  fifth  is  broken,  and  pain  when  the  corresponding  toe  is  pressed 
bodily  backward  against  the  Metatarsus. 

A  simple  fracture  is  not  a  serious  injury,  the  results  usually  being 
most  favorable,  but  a  compound  fracture  may  give  rise  to  suppura- 
tion, necrosis  of  the  fragments,  and  grave  inflammatory  complications. 

Fractures  of  the  Phalanges  are  caused  by  direct  violence  and  are 
usually  compound.  They  are  similar  to  injuries  of  the  hand,  and 
may  give  rise  to  serious  inflammatory  complications. 

Signs  of  Fracture. — The  history  usually  given  by  the  patient  is 
that,  as  the  result  of  some  accident,  he  felt  or  heard  something  give 
way  with  a  snap  and  experienced  sharp  pain  which  became  inten- 
sified on  attempting  to  move  the  part.  On  examining  it  should  be 
contrasted  with  the  other  limb  or  member  and  noted  if  there  is  pain, 
bruising  and  swelling,  also  if  the  skin  is  lacerated  and  torn.  Note 
if  there  is  a  change  in  the  shape  of  the  limb.  In  old  complete  frac- 
tures X-rays   should  be  used  to  make  a  positive  diagnosis. 

Treatment 

First  Aid.— It  is  well  to  know  the  first  aid  treatment  until  a  sur- 
geon  can   be   called.      In   moving   the   patient  from   the  place   of  the 


FRACTURES    AFFECTING    THE    FEET  263 

accident,  first  secure  the  limb  or  member  in  as  good  a  position  as 
is  possible;  improvised  splints  frequently  must  be  resorted  to,  such 
as  sticks,  umbrellas,  newspapers,  etc.  If  a  broken  leg,  it  may  be 
firmly  tied  to  the  other  limb  which  can  be  used  as  a  temporary 
splint.  It  is  then  necessary  to  set  the  broken  parts,  thereby  reduc- 
ing the  deformity.  The  massage  and  manipulation  necessary  to 
bring  about  full  and  complete  use  of  the  parts  then  follow.  This 
work  is  to  be  done  under  the  care  of  an  experienced  surgeon. 


CHAPTER    XXXIV 


DISLOCATIONS    AFFECTING    THE    FEET 

A  displacement  from  each  other  of  the  articular  portions  of  the 
bones  entering  into  the  formation  of  a  joint  may  be  either  perma- 
nent, total  or  partial." 

When  there  is  a  direct  separation,  either  temporary  or  perma- 
nent, of  articular  surfaces,  without  lateral  gliding  of  one  upon  the 
other,  it  is  known  as  a  Diastasis. 

When  the  displacement  is  only  momentary,  the  parts  immediately 
returning  to  their  normal  relations,  the  injury  is  classed  as  a  Sprain. 
When  the  coverings  of  the  joint  are  ruptured,  and  the  joint  cavity 
communicates  with  the  air,  the  dislocation  is  known  as  Compound, 
and  when  the  neighboring  tissues  or  surrounding  parts  are  lacerated 
it  is  said  to  be  Complicated.  Under  circumstances  without  lacera- 
tions it  is  known  as  Simple.  When  the  articulating  surfaces  remain 
in  partial  contact,  the  dislocation  is  termed  Incomplete,  and  when  the 
bones  are  entirely  separated,  it  is  known  as  Complete. 

In  injuries  where  two  or  more  bones  are  simultaneously  dislo- 
cated, as  two  fingers,  a  hip  and  shoulder,  it  is  said  to  be  Multiple.  The 
primitive  or  primary  displacement  is  the  one  immediately  affected 
by  the  causative  violence  which  produces  the  dislocation.  If  the 
dislocated  bone  afterward  shifts  to  another  position,  the  displace- 
ment is  said  to  be  Consecutive  or  Secondary. 

Usually  a  dislocation  is  produced  suddenly  by  great  violence,  or 
by  muscular  action,  or  by  the  combination  of  the  two  acting  together 
on  a  healthy  joint.     Produced  in  this  way,  it  is  called  Traumatic. 

There  are  cases  in  which  the  joint  is  altered  by  disease  previous 
to  the  occurrence  cf  the  dislocation,  this  latter  also  being  affected  by 
the  gradual  action  of  the  muscles  or  by  gravity.  These  dislocations 
are  known  as  Spontaneous,  and  present  many  varieties.     Congenital 

264 


DISLOCATIONS    AFFECTING    THE    FEET  265 

dislocations  are  composed  of  those  in  which  the  dislocation  occurs 
during  intra-uterine  life,  probably  the  result  of  malformation  or  de- 
fective development.  Those  dislocations  produced  during  delivery 
are  Traumatic. 

Dislocations  of  the  Fibula — Of  the  Upper  End — Of  the  Lower 
End. — The  Fibula  may  be  dislocated  at  its  upper  or  at  its  lower  end, 
and  is  caused  by  external  violence,  or  by  muscular  action,  or  by  un- 
equal growth   of  the  Tibia  and   Fibula. 

Dislocations  of  the  Upper  End. — The  displacement  is  usually 
outward  and  forward,  in  others  backward  and  in  a  few  upward.  As 
the  head  of  the  Fibula  is  situated  behind  the  most  external  part  of 
the  Tibia,  a  forward  dislocation  must  also  be  outward.  Numerous 
cases,  complicated  by  a  fracture  of  either  the  Tibia  or  Fibula  or  of 
both  bones,  have  been  reported. 

Dislocation  Forward. — A  fall  with  the  leg  bent  under  the  body 
or  a  muscular  effort  without  a  fall  are  causes  that  will  produce  a 
forward  dislocation  of  the  Fibula;  also  there  is  a  belief  that  the 
forcible  depression  and  inversion  of  the  foot  may  be  a  factor  in  the 
production.  The  head  of  the  Fibula  can  be  seen  and  felt  in  front  and 
outside  of  its  normal  position,  and  the  tendon  of  the  biceps  shows 
plainly  in  any  unusual  curve.  Because  of  pain  the  patient  usually 
is  unable  to  walk,  but  free  movement  of  the  knee  is  possible. 

Backward. — Forcible  contraction  of  the  biceps,  a  twisting  of  the 
leg  with  rupture  of  the  Tibio-Fibular  attachments  by  the  pull  of  the 
External  Lateral  ligament  of  the  knee,  the  biceps  acting  to  displace 
the  bone  backward,  are  causes  which  produce  a  backward  disloca- 
tion. 

Upward. — There  are  only  three  cases  of  this  form  reported,  those 
of  Boyer,  Stall  and  Sorbets.  In  Boyer's  case  the  patient  appears  to 
have  received  a  dislocation  outward  of  the  foot,  or  a  Pott's  fracture 
of  the  ankle.  The  Fibula,  instead  of  breaking,  had  been  pushed 
bodily  upward ;  the  upper  dislocation  was  corrected  after  the  foot 
was  restored  to  its  place,  with  recovery  of  the  patient. 


266  THE    HUMAN    FOOT 

Dislocations  at  or  Near  the  Ankle — Dislocations  of  the  Foot  (Tibio- 
Tarsal) — Sub-Astragaloid — Total  Dislocation  of  the  Astragalus — 
Medio-Tarsal — Congenital. 

ANATOMY 

The  principal  movements  of  the  foot  are  those  of  flexion  and 
extension  or  Dorsal  and  Plantar  flexion,  which  take  place  in  the 
joint  formed  by  the  x-\stragalus,  Tibia  and  Fibula,  and  that  of 
adduction  and  abduction  and  respectively  combined  with  inversion; 
eversion  of  the  sole,  which  takes  place  in  the  joints  between  the 
Astragalus  on  one  side  and  the  Calcaneum  and  Scaphoid  on  the 
other,  being  aided  by  slight  motion  between  the  Os  Calcis  and 
Cuboid.  The  axis  of  the  first  joint,  which  is  the  ankle,  is  horizontal 
and  almost  transverse,  the  inner  end  inclining  forward,  the  other 
end  running  obliquely  from  a  point  near  the  inner  tuberosity  of 
the  Calcaneum  upward  and  forward  to  a  point  on  the  upper  surface 
of  the  neck  of  the  Astragalus.  The  Astragalus  articulates  above 
with  the  under  surface  of  the  Tibia,  on  the  sides  with  the  Malleoli, 
between  which  it  is  placed  so  securely  that  lateral  motion  is  im- 
possible. From  the  Malleoli  the  lateral  ligaments  pass  on  each  side  to 
the  Astragalus  and  Calcaneum,  the  lower  ends  of  the  Tibia  being 
bound  together  by  ligaments  in  front  and  behind.  The  range  of 
Dorsal  and  Plantar  flexion  is  about  ninety  degrees.  Thus  the  articu- 
lar surface  of  the  Astragalus,  being  somewhat  narrower  behind  than 
in  front,  lateral  motion  of  the  joint  is  possible  when  in  full  Plantar 
flexion. 

The  head  of  the  Astragalus,  which  is  round,  articulates  with  the 
posterior  concave  surface  of  the  Scaphoid,  the  Inferior  Calcaneo- 
Scaphoid  ligament  and  slightly  with  the  anterior  end  of  the  Cal- 
caneum. Between  them  is  the  strong  Interosseous  ligament,  which 
fills  the  canal  formed  by  a  groove  on  each  bone  separating  its  two 
articular  surfaces,  binding  the  bones  firmly  together.  The  maximum 
range  motion  of  these  joints  is  about  forty  degrees,  and  is  limited 
partly  by  the  ligament  and   bony  contact. 


DISLOCATIONS    AFFECTING    THE    FEET  267 

Dislocations  of  the  Foot — Tibio-Tarsal  Dislocations. — Displace- 
ments of  the  Astragalus  and  foot  are  so  complex  that  the  nomen- 
clature of  the  various  dislocations  occasions  serious  difficulty  and 
much  confusion.  To  facilitate  the  study  of  dislocation  I  shall  use 
in  the  classifications  four  terms,  namely  :  Dislocations  Forward,  Back- 
ward, Outward  and  Inward.  Of  the  four  the  first  two  are  pure  dis- 
locations, the  latter  being  frequently  placed  cases  in  which  the  dis- 
placement is  associated  with  fracture  of  one  or  both  bones  of  the  leg. 

Dislocations  Backward — Dislocation  of  the  Lower  End  of  the 
Tibia  Forward. — In  these  dislocations  the  Astragalus,  and  with  it 
the  foot,  is  displaced  backward.  The  distance  of  the  displacement 
is  variable,  and  there  is  also  a  rupture  of  the  lateral  ligaments  and 
at  times  of  other  parts  of  the  capsule,  with  fracture  of  one  or  both 
Malleoli  or  of  the  posterior  edge  of  the  lower  articular  surface  of 
the  Tibia. 

Extreme  Plantar  flexion  of  the  foot  is  usually  the  cause,  in  which 
the  posterior  border  of  the  end  of  the  Tibia  comes  into  contact 
with  the  posterior  tip  of  the  Astragalus,  establishing  a  new  center 
of  motion  behind  the  line  of  the  Malleoli.  Continued  movement  rup- 
tures the  lateral  and  anterior  ligaments.  Thus  the  bones,  being  freed, 
the  Tibia  is  pushed  forward  over  the  Astragalus,  or  the  foot  may 
be  pushed  backward  under  the  Tibia,  depending  how  the  causative 
violence  acts  upon  the  leg  or  foot.  The  first  step  is  a  rupture  of 
the  ligaments,  and  the  fixation  of  the  Astragalus  behind  the  Tibia 
takes  place  by  correction  of  the  Plantar  flexion.  The  injury  is  com- 
monly produced  by  a   fall  backward  while  the   foot   is   fixed. 

In  clinical  and  post  mortem  examinations  the  lesions  found  were 
the  same,  fracture  of  the  External  Malleolus  is  common,  and  at  times 
fracture  of  the  Internal  Malleolus  and  of  the  posterior  articular  border 
of  the  Tibia  is  seen. 

In  the  front  the  foot  appears  shortened  and  the  heel  lengthened,  to 
an  extent  conforming  to  the  degree  of  displacement,  about  an  inch 
being  the  maximum.  The  lower  end  of  the  Tibia  projects  and  is 
more  or  less  marked  in  front,  and  at  times  is  exposed  by  rupture 
of  the  skin.     The  Extensor  tendons  can  be  felt,  as  tense  cords  cross- 


268  THE    HUMAN    FOOT 

ing  to  the  Dorsum  of  the  foot,  and  the  Achillis  tendon  curves  back- 
ward to  the  heel,  leaving  on  each  side  a  marked  depression  between 
it  and  the  Malleolus.  The  toes  may  be  depressed,  and  perhaps 
abducted  or  adducted.  The  Malleolus  accompanies  the  foot  in  its 
displacement  backward  if  the  Fibula  is  broken. 

Dislocations  Forward. — As  in  the  preceding  case,  this  dislocation 
displaces  the  Astragalus  and  with  it  the  foot,  but  forward  from 
beneath  the  Tibia.  Cases  of  this  character  are  much  rarer  than  the 
preceding. 

It  may  be  produced  by  Dorsal  flexion  of  the  foot  followed  by 
impulsion  of  the  Tibia  downward  and  backward,  by  a  force  acting 
in  the  direction  of  its  long  axis,  or  by  direct  pressure  of  the  foot 
forward  and  of  the  leg  backward  while  they  are  at  right  angles  to 
each   other. 

The  symptoms  are  lengthening"  of  the  front  of  the  foot  and 
shortening  of  the  heel.  The  depressions  on  each  side  of  the  Tendo- 
Achillis  are  effaced  and  the  foot  is  in  the  position  of  more  or  less 
Plantar  flexion.  The  hollow  of  the  instep  may  be  exaggerated,  and 
the  upper  articular  surface  of  the  Astragalus  can  be  felt  in  front  of 
the  end  of  the  Tibia  and  also  the  Malleoli  are  nearer  to  the  heel  and 
to  the  sole  than  normal. 

Dislocations  Inward  are  those  cases  where,  by  adduction  and 
inversion,  the  foot  is  moved  downward  and  to  the  inner  side  so 
that  the  Astragalus  leaves  the  Tibio-Fibular  mortise  more  or  less 
completely.  There  are  two  distinct  forms,  one  in  which  the  foot 
is  markedly  inverted  and  the  upper  surface  of  the  Astragalus  can 
be  seen  and  felt  raising  the  skin  under  the  External  Malleolus,  and 
the  other  when  the  inversion  of  the  foot  is  less  or  absent  and  there 
is  marked  adduction,  sometimes  causing  the  ends  of  the  toes  to  point 
directly  inward.  The  common  cause  is  usually  a  fall  from  some  high 
point. 

Dislocations  Outward  are  almost  without  exception  those  which 
are  now  commonly  known  as  Pott's  fracture  at  the  ankle,  and  have 
been  described  in  the  previous  chapter  as  fracture  by  eversion  and 
abduction  of  the   foot. 


DISLOCATIONS    AFFECTING    THE    FEET  269 

Compound  and  Complicated  Dislocations  of  the  Foot. — A  disloca- 
tion of  the  foot  may  be  compound,  primarily  or  secondarily,  also  the 
bones  of  the  leg  or  the  Astragalus  may  protrude  through  the  wound, 
and  they  may  be  complicated  by  rupture  of  the  blood  vessels  and 
by  fractures  other  than  those  of  the  Malleoli. 

The  wound  of  the  skin  in  a  dislocation  that  is  primarily  com- 
pound may  be  made  from  within,  by  the  projection  of  the  bone  or 
by  contact  with  the  ground.  In  those  that  become  secondarily 
compound  the  sloughing  of  the  soft  parts  may  be  due  to  the  pressure 
of  the  unreduced  bones,  or  to  bruising  of  the  soft  parts  inflicted  at 
the  time  of  dislocation. 

SUB-ASTRAGALOID   DISLOCATIONS 

Dislocation  of  the  Astragalo-Calcaneoid  and  the  Astragalo- 
Scaphoid  Joints. 

Those  forms  known  as  dislocations  backward,  inward  and  out- 
ward of  the  Os  Calcis  and  Scaphoid  from  the  Astragalus  were 
recognized  in  Broca's  plan  of  subdivision.  Malgaine,  an  eminent  French 
surgeon,  added  a  fourth  variety  dislocations  forward,  and  changed 
the  nomenclature  by  treating  the  Astragalus  as  the  dislocated  bone, 
applying  the  terms  indicative  of  the  direction  of  the  displacement  in 
accordance   to   its    position   with    relation   to   the   others. 

The  dislocation  thus  presents  four  varieties :  Displacement  of 
the  Os  Calcis  and  Scaphoid  inward  and  somewhat  backward,  with 
the  head  of  the  Astragalus  projecting  on  the  outer  part  of  the 
Dorsum  of  the  foot,  their  displacement  outward  and  their  displace- 
ment directly  forward  or  backward  and  downward.  The  occurrences 
of  the  first  two  are  of  equal  frequency  and  comprise  the  greater 
number  of  cases.     The  last  two  are  of  less  frequent  occurrence. 

Dislocations  Inward  or  Inward  and  Backward. — Forcible  inversion 
and  adduction  of  the  foot  combined  with  violence  acting  in  the  direc- 
tion of  the  long  axis  of  the  leg  as  in  a  fall  from  some  height  are  the 
usual  causes.     The  displacement  is  very  seldom,  if  ever,  directly  in- 


270  THE    HUMAN    FOOT 

ward,  but  it  is  also  slightly  backward  so  that  the  head  of  the  Astra- 
galus rests  partly  upon  the  Cuboid. 

Symptoms. — Shortening  of  the  Dorsum  of  the  foot  and  lengthen- 
ing of  the  heel,  adduction  of  the  toes,  elevation  of  the  inner  border 
of  the  foot,  prominence  of  the  tip  of  the  External  Malleolus  and  the 
head  of  the  Astragalus  on  the  outer  side  of  the  Dorsum  with  marked 
depression  of  the  soft  parts  below  each ;  the  Internal  Malleolus  is 
deeply  placed  under  the  skin.  Below  and  behind  it  can  be  felt  the 
Sustentaculum  Tali,  and  in  front  the  inner  surface  of  the  Scaphoid. 

Dislocations  Outward. — There  are  two  varieties  and  they  are  dis- 
tinguished by  marked  abduction  of  the  toes  in  one  and  absence  in  the 
other.  In  the  former  the  posterior  articular  surface  of  the  Astragalus 
is  not  separated  from  the  Calcaneum,  but  the  foot  has  turned  upon 
the  outer  part  of  the  Interosseous  ligament  as  a  center,  the  Scaphoid 
being  carried  to  the  outer  side  of  head  of  the  Astragalus,  and  some- 
times is  turned  upward  or  downward.  In  the  other  form,  without 
abduction  of  the  toes,  the  foot  is  displaced  bodily  outward  from 
beneath  and  in  front  of  the  Astragalus.  The  cause  in  the  former 
appears  to  be  forcible  abduction  of  the  foot,  and  in  the  latter  it  is 
either  abduction  and  eversion  of  the  foot  or  it  may  be  great  violence 
exerted  against  the  inner  side  of  the  foot  or  the  outer  side  of  the  lower 
part  of  the  leg.  It  may  be  a  primary  or  secondary  compound,  as  the 
head  of  the  Astragalus  may  project  entirely  through  the  skin. 

Symptoms. — The  form  in  which  displacement  is  directly  out- 
ward is  a  marked  displacement  of  the  foot,  with  little  if  any  eversion 
or  abduction.  In  the  place  of  the  usual  prominence  found  by  the 
External  Malleolus  and  the  he'ad  of  the  Astragalus  there  is  a  notable 
depression.  The  Internal  Malleolus  is  very  prominent  and  nearer 
to  the  level  of  the  sole,  and  below  and  in  front  of  it  the  head  of  the 
Astragalus  projects.  The  Scaphoid,  with  a  depression  behind  it,  is 
recognizable  on  the  Dorsum   of  the  foot. 

Dislocations  Backward. — In  this  form  the  Calcaneum  and  Scaphoid 
are  displaced  directly  backward,  the  Scaphoid  descending  to  a  lower 
level  so  as  to  lie  under  the  head  or  neck  of  the  Astragalus. 

Dislocations    Forward. — Only   two    examples    of    this    form    have 


DISLOCATIONS    AFFECTIXG    THE    FEET  271 

been  reported,  one  by  Parise,  quoted  by  Malgaine.  the  other  by 
Broca.  In  Parise's  case  the  patient  was  injured  by  being-  crushed 
under  a  heavy  weight.  The  thigh  was  flexed  on  the  trunk,  the  leg 
on  the  thigh,  and  the  foot  on  the  leg  (Dorsal  flexion).  After  a  period 
of  nine  months  this  condition  was  as  follows :  The  foot  was  at  a 
right  angle  with  the  leg,  somewhat  adducted  and  very  slightly 
everted.  There  was  a  displacement  forward,  making  it  appear  length- 
ened in  front  and  with  the  External  Malleolus  almost  touching  the 
Tendo-Achillis.  On  the  instep  the  Extensor  tendons  were  tense  with- 
out palpable  prominence  beneath  them,  but  on  the  outer  side  a  bony 
prominence  could  be  felt  which  was  thought  to  be  the  Astragalus ; 
immediately  in  front  there  was  a  depression  which  admitted  the 
finger  and  the  hollow  between  the  Astragalus  and  Calcaneum  ap- 
peared to  be  filled.  The  prominence  of  the  heel  behind  was  com- 
pletely lost,  the  leg  flattened  and  its  surface  interrupted  at  the  level 
of  and  a  little  below  the  Malleoli,  by  a  bony  prominence  which  raised 
the  Tendo-Achillis  and  overlapped  the  heel  about  half  an  inch;  above 
this  another  less  prominent  being  formed  by  the  posterior  articular 
edge  of  the  Tibia.  There  was  no  trace  of  fracture  or  separation  of 
the  Malleoli.  The  motion  in  the  Tibio-Tarsal  joint  was  slight  and  in 
the  joints  of  the  Tarsus  entirely  lost.  The  patient  required  crutches 
to  walk.     The  displacement  in  Broca's  case  was  much  less  marked. 

Total  Dislocation  cf  the  Astragalus. — Dislocations  of  the  Astrag- 
alus are  usually  compound  and  the  varieties  very  numerous.  They 
may  be  grouped  as  dislocations  forward,  backward,  outward  and 
forward  and  inward  and  forward,  these  terms  indicating  in  which 
direction  the  Astragalus  is  displaced,  and  dislocation  by  rotation  in 
which  the  bone  remains  within  the  mortise.  The  most  common 
causes  are  falls  from  some  height  upon  the  feet  or  a  violent  twisting 
of  the  foot. 

Medio-Tarsal  Dislocation. — In  this  form  the  dislocation  takes  place 
in  the  Medio-Tarsal  joint.  The  Scaphoid  and  Cuboid  are  together 
displaced  from  the  Astragalus  and  Calcaneum  which  retain  their  rela- 
tions to  each  other  and  to  the  bone  of  the  leg. 


272  THE    HUMAN    FOOT 

DISLOCATIONS    OF    THE    TARSAL    AND    METATARSAL 

BONES 

The  bones  of  the  Tarsus  may  be  dislocated  separately  and  in 
various   combinations. 

Calcaneum. — The  Calcaneum  may  be  bodily  displaced  to  the  outer 
side  without  apparently  being  entirely  separated  from  the  Astragalus 
and    Scaphoid. 

Scaphoid. — The  Scaphoid  has  been  dislocated  forward  and  out- 
ward in  connection  with  the  Astragalus,  the  dislocation  being  com- 
pound. 

Cuboid. — One  case  reported  by  Bell  in  which  the  Cuboid  was 
displaced  upward  in  connection  with  the  fifth  Metatarsal  by  inversion 
and  abduction  of  the  foot. 

Cuneiform  Bones. — The  three  Cuneiform  bones  and  the  second 
and  third  Metatarsals  have  been  displaced  together ;  also  the  first  and 
second  Metatarsals  have  been  displaced  separately. 

DISLOCATIONS  OF  THE  METATARSAL  BONES  FROM  THE 
TARSUS  AND  FROM  ONE  ANOTHER 

The  first  Metatarsal  is  more  frequently  dislocated  than  the  others, 
and  the  displacement  is  usually  upward.  The  symptoms  often  in- 
dicate the  co-existence  of  a  sprain  of  the  neighboring  joints. 

All  the  Metatarsals  may  be  displaced  together  upward,  inward, 
downward  or  outward. 

Subluxation  of  the  Head  of  a  Metatarsal  Bone. — As  described  by 
Morton  the  head  of  the  fourth  Metatarsal  appears  to  be  displaced 
from  its  normal  relations  with  the  adjoining  one  on  each  side,  also 
with  its  toes ;  it  is  less  frequent  in  the  third. 

DISLOCATIONS  OF  THE  TOES 

Metatarso-Phalangeal  Dislocations — Dislocations  of  the  Great 
Toe. — The  cause  most  common  is  a  fall  upon  the  toe.  It  may  be 
caused  by  kicking,  receiving  the  weight  of  the  body  upon  the  toe ;  also 
by  violence  received  upon  the  Metatarsus.    The  injury  is  usually  com- 


DISLOCATIONS    AFFECTING    THE    FEET  273 

pound.  The  dislocation  appears  most  frequently  to  be  on  the  outer 
side  and  backward,  and  secondly  those  directly  backward,  the  former 
being  always  compound  with  the  head  of  the  Metatarsal  bone  project- 
ing through  the  wound  on  the  inner  and  lower  aspect  of  the  joint. 
It  also  has  been  upward  and  backward  to  one  side.  Sprain  or  sub-  ■ 
luxation  of  the  first  Tarso-Metatarsal  joint  has  often  been  noted. 

Dislocations  of  the  Other  Toes. — The  four  outer,  the  four  inner 
or  all  of  the  five  may  be  displaced  upward  and  backward  or  directly 
outward. 

Dislocation  of  the  Phalanges. — The  dislocation  most  frequent  is 
that  of  the  Terminal  Phalanx  of  the  great  toe. 


18 


CHAPTER    XXXV 


CORNS    (CORNU,    HORN) 

In  this  chapter  it  is  proposed  to  touch  briefly  on  Corns,  Bunions 
and  Callosities  known  to  result  from  the  unequally  disposed  pressure 
of  ill-fitting  boots  and  shoes  and  other  removable  evils. 

In  dealing  with  corns  it  is  well  to  know  that  there  are  several 
varieties  of  corns,  such  as  hard  and  soft  corns,  suppurated  corns  and 
Xervo- Vascular  corns.    They  may  be  defined  as  follows : 

Hard  Corn. — A  horny  induration  and  thickening  of  the  skin,  pro- 
duced by  friction  and  pressure  ;  a  conic  mass  is  formed  that  extends 
down  into  the  derma,  causing  pain  and  irritation. 

Soft  Corn. — A  soft  thickening  of  the  epidermis  between  the  toes, 
which  is  kept  soft  and  irritated  by  the  moisture  and  pressure  of  the 
toes. 

Suppurated  Corn. — Similar  to  hard  and  soft  corn,  but  accom- 
panied by  pus  and  infection. 

Nervo-Vascular  Corn. — Forms  on  toe  joints  or  where  the  skin  is 
unusually  vascular. 

Vascular  Corn. — A  deep  seated  or  vascular  substance,  forming  a 
circumscribed  tumor  in  which  the  papillary  capillaries  have  obtruded 
themselves  beyond  their  normal  place,  and  is  found  on  the  sole  or 
heel  of  the  foot.  The  conditions  of  the  formations  described  above  are 
often  modified  and  are  known  as  blood  corns,  warty  corns,  neuro- 
fibrous  or  nerve  corns,  laminated,  ulcerated  corns  and  festered  corns, 
etc.  But  these  terms  merely  apply  to  conditions  arising  in  the  course 
of  development  and  usually  denote  a  symptom  or  somewhat  altered 
appearance  of  those  which  are  true  corns.  These  corns  are  often  a 
source  of  great  pain,  their  formation  creating  a  pressure  which  gives 
rise  to  pain  of  various  gradations,  from  a  dull  pain  to  that  similar  to 
a  toothache.    The  pain  is  intensified  by  climatic  changes,  and  it  is  an 

274 


CORNS 


275 


undisputed  fact  that  on  the  approach  of  a  rainstorm  or  in  a  humid 
atmosphere  the  pain  in  the  feet  of  those  who  suffer  from  corns  is  in- 
creased. Corns  result  from  pressure  and  friction  and  are  caused  by 
tisrht  or  loose  and  ill-fittine  shoes. 


Chart  No.   167 
Foot   Covered   with   Hard   Corn   Growths. 


HARD    CORNS 
Hard  Corn  is  a  small  conical  shaped,  deep-seated  horny  formation 
usually  found   about  the   toes,   the  apex  of  this   formation   pressing 
down  upon  the  corium  of  the  skin.     They  range  in  size  from  a  pin- 
head  to  the  size  of  a  pea.    Although  these  growths  are  more  frequently 


-B 


Chart  No.   168 
Showing  Hard   Corn  Pressing  Down   into   Skin.     A,   Epidermis;   B,  Derma. 


found  on  the  foot  they  may  appear  on  any  part  of  the  body  where  pres- 
sure or  friction  is  maintained.  The  most  common  variety  is  Hard 
Corn  and  its  structure  is  hard  and  is  usually  found  on  the  Dorsum  of 
the  foot. 


276 


THE    HUMAN    FOOT 


Chart  No.  169 

Corns   on    Second   and    Fifth    Toe   and   on 

Bunion  Joint. 


Chart  No.   170 
Corns  on   Second.  Fourth  and  Fifth  Toe. 


CORNS 


277 


The  hard  corn  is  formed  by  friction  rather  than  by  pressure.    The 
process  has  been  thus  described :    "The  hard  corn  is  produced  by  the 


Chart  No.  171 
Felt    Kiro    Pads    Applied    with    Adhesive    Plaster. 

constant  pressure  and  friction  of  a  tight  or  small  shoe  or  a  large  shoe 
against  the  projection  point  of  some  prominent  bony  surface,  as  on 


Chart  No.  172 
Medicated  Corn   Plaster  with  Pad  Applied  to  Toe. 

the  last  joints  of  third,  fourth  and  little  toe.     If  the  action  is  kept  up, 
a   sense   of   pain   is   experienced,   which   produces   inflammation;   rest 


278 


THE    HUMAN    FOOT 


decreases  this  inflammation,  leaving'  induration  behind  it.     Renewed 
action   from    the   preceding"   causes   reproduces   the   same   effects,    in- 


\ 

\  /~y      £ 

\ 

%  %■  I  .^ 

ekij 

1     - 

K      =                   \ 

\  er.l 

c 

z© 

Chart  No.   173 
Applying    Pedico     Corn     Salve  Fad    in    Place    Covered 

Inside    of    Felt   Pad.  with  Tape. 

flammation  again  ensues  which  in  its  turn  is  equally  decreased  either 
by  rest  or  a  temporary  removal  of  the  cause,  leaving  behind  a  second 
or  accumulated  desrree  of  induration. 


Chart  No.   174 

Rubber   Pads   for   Corns.   Hammer   Toes  and 

Tender  Joints. 


Very  frequently  extraordinary  friction  is  produced  against  the 
toe  where  the  foot  is  crowded  and  forced  into  the  toe  of  the  shoe, 
caused  by  a  weakened  arch.     This  can  be  relieved  by  fitting  a  light 


CORNS 


279 


arch  support  or  foot-eazer  that  will  hold  up  the  arch  and  draw  the 
foot  back  and  hold  it  there. 

This  continued  action  and  reaction  bring-  on  a  collosity  rising 
above  the  surface  of  the  skin,  which  increases  from  its  bases  in  pro- 
portion to  the  excess  or  diminution  of  the  exciting  cause.  Once 
formed,  pressure  alone  will  suffice  to  sustain  it." 


H          Br 

■L 

Ik  ■ 

'  ■  H 

■                                                WgL_     ■                      i 

Chart  No.  175 
Showing   Zin-Ox   Water-proof   Healing   Pads. 

Treatment. — An  ordinary  hard  corn  of  recent  formation  may  be 
removed  by  scraping  off  the  callous  skin  around  its  border  and  re- 
moving it  carefully  with  a  knife,  taking  care  that  the  under  skin  is 
not  cut  through.  In  doing  so,  all  septic  precautions  must  be  ob- 
served and  a  special  corn  knife  should  be  used.  This  operation  is 
exceedingly  dangerous  in  the  hands  of  an  inexperienced  operator. 


280 


THE    HUMAN    FOOT 


Corn  removers  which  contain  such  as  salicylic  acid  and  cannabis 
indica  with  flexible  collodion  or  in  an  ointment  base  are  universally 
used  and  at  times  afford  relief  by  continued  application,  but  three 
forms  that  have  been  used  with  much  success  and  advocated  by  me 
to  remove  hard,  thickened  growth  are  known  as  pedico  corn  salve, 
two-drop  liquid  corn  remover  and  fixo  medicated  corn  plaster. 

As  a  preventive  measure  to  remove  pressure  from  the  conical- 
shaped  growth  known  as  hard  corns,  pads  made  irpm  layers  of 
oxide  of  zinc  plaster,  cut  to  the  necessary  oval  shape  with  a  heavier 


Chart  No.  176 
How  Pressure   is   Removed  by  Kiro   Pads. 


outside  shoulder  for  protection,  prove  very  useful.  Pads  such  as  those 
described  above,  cut  in  various  shapes,  are  on  the  market  ready  for 
use  and  are  known  as  zin-ox  pads,  which  make  a  convenient  water- 
proof, antiseptic  and  healing  protection. 

Felt  skived  pads  in  oval,  round  and  concave  shapes  are  very 
beneficial  in  protecting  the  parts  from  pressure  of  the  shoe.  Author's 
kiro  pads,  consisting  of  live  wool  felt  automatically  skived  to  many 
shapes  and  thicknesses,  also  afford  relief,  and  are  especially  beneficial 
after  the  corn  has  been  removed. 


CORNS 


281 


Pads  of  rubber  and  gutta  percha,  moulded  in  sizes  and  shapes  to 
conform  to  the  shape  of  toes  or  affected  parts,  having  an  outside 
border  or  shoulder  and  conical  opening  to  fit  over  the  corn,  will 
remove  the  friction  and  pressure.  These  pads  thus  made  and  used 
by  me  are  known  as  absorb©  pads.  By  relieving  pressure  and  main- 
taining the  body  warmth  the  skin  secretions  are  promoted,  conse- 
quently causing  the  horny,  callous  growth  to  separate  from  the  healthy 
tissue. 

SOFT    CORNS 

Soft  corns  are  always  found  between  the  toes  and  are  kept  con- 
tinually moist  by  the  excretions  between  the  toes.  They  never  become 
hard   like   those   found   on   the   top   of  the  toes.     They  are   not   deep 


Chart  No.  177 
Toe-Right  for  Soft  Corns. 


seated  and  do  not  project  above  the  surrounding  surface.  They  are 
constantly  subjected  to  pressure  which  keeps  them  fiat.  Soft  corns 
are  nearly  always  present  where  the  Metatarsal  bones  have  become 
slightly  displaced,  which  forces  the  Phalanges  of  the  toes  against  the 
other  members.  They  are  usually  caused  by  pressure  of  the  joint  of 
an  adjacent  toe  against  the  one  where  the  corn  is  formed.  If  the 
pressure  is  very  severe  it  may  produce  inflammation,  which  ends  in 
suppuration. 


282  THE    HUMAN    FOOT 

The  first  sign  of  a  soft  corn  is  a  feeling  of  burning  between  the 
toes ;  a  blister  soon  forms  and  the  escaping  exudation  irritates  the 
surrounding  skin.  If  the  blister  does  not  break,  the  fluid  hardens 
and  forms  the  corn.  'When  the  exudation  escapes,  the  skin  becomes 
inflamed  and  new  thick  layers  take  the  place  of  the  cuticle,  and  the 
corn  is  formed.  When  the  corn  reaches  its  growth  it  produces  a 
feeling  as  though  there  were  a  grain  of  sand  or  a  small  pea  between 
the  toes. 

When  a  soft  corn  commences  with  severe  inflammation,  the  skin 
becomes  thickened  and  a  corn  is  formed  at  the  point  where  pressure 
is  greatest.  It  shows  a  circular  form  and  a  dirty  red  or  light  brown- 
color.  If  the  corn  is  neglected,  ulceration  sometimes  follows,  causing 
inflammation  of  the  entire  foot,  and  may  also  extend  to  the  leg  at- 
tended with  severe  pain. 

Sometimes  a  soft  corn  will  show  a  white  spongy  thickening  of  the 
skin.  It  may  at  times  appear  as  a  white  spot  or  like  a  split  pea.  It 
may  also  show  a  white  thickening  of  the  skin  rising  into  a  pustule. 
With  an  opening  in  the  center,  sometimes  a  soft  corn  forms  at  the 
inner  side  of  the  great  toe  and  near  the  end  of  the  second  toe.  In 
old  people  whose  feet  show  little  moisture,  the  corn  is  harder  than 
usual. 

Treatment. — First  remove  the  existing  cause.  If  produced  by 
dropping  of  one  of  the  Metatarsal  heads,  fit  the  patient  to  Anterior 
Metatarsal  arch  supports  to  correct.  Then  thoroughly  cleanse  the 
parts,  dust  with  antiseptic  powder  and  apply  a  toe-right  to  separate 
the  toes.     Stockings  and  shoes  should  be  looked  into. 

SUPPURATED  CORNS 

Corns  situated  on  the  tops  of  the  toes  near  prominent  joints  are 
found  to  suppurate  when  severe  pressure  or  irritation  is  exerted. 
They  may  be  either  hard  or  soft.  The  first  symptom  is  indicated  by 
redness  over  the  joint  and  the  toe  is  extremely  sensitive  to  the  slight- 
est pressure,  inflammation  sets  in  and  pus  forms  under  the  corn  and 
in  the  bursa  beneath,  when  the  corn  is  extracted  it  generallv  has  a 


CORNS  283 

part  of  the  bursal  sac  adhering  to  it,  sometimes  the  bursa  is  diseased. 
Without  any  thickening  of  the  outer  skin  the  only  external  appearance 
is  the  redness  and  swelling  to  the  toe  with  a  small  white  spot,  having 
a  minute  speck  in  the  center.  Later  they  will  fester,  and  pus  bacteria 
are  present,  with  swelling  and  intense  pain. 

Treatment. — Parts  must  be  thoroughly  cleansed  with  a  reliable 
antiseptic,  and  padding  applied.  After  suppuration  ceases,  a  healing 
salve  should  be  applied  with  a  pad  to  protect  from  further  pressure. 

NERVO-VASCULAR    CORNS 

Nervo-vascular  corns  form  in  the  toe  joints  of  persons  whose  skin 
is  unusually  vascular ;  they  easily  become  inflamed  from  pressure. 
When  these  corns  become  developed,  the  skin  covering  them  is 
slightly  thickened  and  semitransparent.  They  have  villi  or  nervous 
fibres  running  in  zigzag  whitish  lines  within  the  induration,  small 
corns  appearing  between  them  like  white  specks  corresponding  in 
the  form  to  the  cells  they  occupy,  although  the  outer  skin  of  these 
corns  is  no  more  sensitive  than  any  other  thickening.  The  nervous 
filaments  are  so  sensitive  that  the  slightest  pressure  of  a  shoe  can 
hardly  be  borne  and  in  operating  on  these  corns  a  great  deal  of  pain 
is  caused.  This  species  of  corn  is  caused  by  more  severe  pressure 
on  the  part  than  is  necessary  to  cause  the  ordinary  corn;  therefore  a 
more  severe  inflammation  is  caused,  so  that  the  true  skin,  subject  to 
compression,  participates  and  is  vascular,  and  the  nerve  fibres  be- 
come enlarged  to  a  great  extent. 

When  the  inflammation  has  been  reduced  to  some  extent  by 
means  employed  by  the  patient,  the  enlarged  structures  do  not  return 
to  normal,  but  constitute  a  network  in  whose  meshes  is  deposited  the 
matter  produced  by  the  thickening  of  the  skin,  that  is  continually 
going  on,  which,  becoming  condensed,  forms  the  small  corns  situated 
between  the  nervous  fibres.  By  the  time  the  inflammation  has  entirely 
ceased,  these  nervous  filaments  are  completely  matted  within  the  outer 
skin. 


284  THE    HUMAN    FOOT 

Treatment. — The  treatment  consists  of  applying  salicylic  soap 
plaster.    Then  apply  an  absorbo  pad  or  a  thin  felt  kiro  pad  to  remove 

pressure. 

VASCULAR    CORNS 

Vascular  corns  are  very  painful.  They  are  generally  situated  on 
the  sole  of  the  foot,  upon  the  plantar  muscle,  or  the  under  side  of  the 
heel,  also  on  the  little  toe,  and  sometimes  on  the  sides  of  the  large 
toe  close  under  the  nail.  They  are  easy  to  tell  from  a  common  corn, 
having  more  the  appearance  and  character  of  a  wart,  but  they  cannot 
be  called  warts,  as  warts  are  found  mostly  on  the  hands  and  fingers 
and  on  parts  where  there  is  no  pressure.  Warts  are  seldom  painful  and 
grow  without  apparent  cause.  Vascular  corns  are  always  painful, 
and  are  never  produced  without  previous  irritation. 

This  corn  consists  of  a  deep-seated  spongy  or  vascular  substance, 
forming  a  circumscribed  tumor  and  does  not  project  much  beyond 
the  level  of  the  thickened  skin.  When  developed  its  whole  surface 
is  studded  with  red  and  black  specks  and  the  surrounding  integument 
is  inflamed  and  swollen.  In  some  cases  these  minute  extravasations 
are  not  distinctly  defined.  The  corn  then  appears  as  a  softened  tuft; 
the  vascular  fibres  of  which  it  is  composed  seem  to  be  of  unequal 
length.  When  an  attempt  is  made  to  remove  this  corn  with  a  knife, 
hemorrhage  follows  to  a  considerable  extent,  all  of  the  minute  vessels 
pouring  forth  their  contents  very  profusely.  I  have  never  seen  a 
case  that  presented  any  malignant  symptoms ;  they  always  yield 
readily  to  proper  treatment,  and  the  disease  rarely,  if  ever,  returns. 
In  most  of  these  cases  you  will  find  the  flesh  of  the  feet  moist  and 
clammy  and  the  skin  thin.  It  is  not  prevalent  in  children  under  ten 
years,  or  in  aged  persons.     It  is  more  common  in  men  than  in  women. 

In  the  first  stages  it  is  characterized  by  a  burning  sensation  in  the 
part  affected  and  is  very  sensitive  to  pressure  and  attended  by  an 
aching,  throbbing  pain,  particularly  after  walking,  when  the  shoe  has 
been  removed  and  on  lifting  the  foot  from  the  ground.  It  is  always 
hard  to  find  a  satisfactory  cause  for  this  complaint. 

Treatment. — Owing  to  complications  which  may  arise,  these  con- 
ditions should  be  treated  by  cauterization  at  the  hands  of  a  surgeon. 


CHAPTER    XXXVI 


CALLOSITIES— CALLOUS 

Callous  is  a  thick,  hardened  area  of  skin,  usually  caused  by  pres- 
sure or  friction  which  causes  an  excessive  accumulation  of  corneous 
or  horny  layer,  and  a  congestion  of  the  pores  of  the  skin,  occurring 
most  frequently  on  the  soles  of  the  feet.     Callosities  are  acquired 


Chart  No.  178 
Callouses  on   Sole  Caused  by  Metatarsalgia. 


formations  and  present  areas  of  various  sizes  and  of  a  gray  or  yellow 
color.  Beyond  the  thickening,  no  other  material  alteration  takes  place 
on  the  cuticle,  for  the  numerous  lines  and  furrows  of  the  skin  can  be 
seen  in  continuation  of  the  normal  integuments.  This  hard-like  and 
horny  formation  is  frequently  caused  by  long  continued  friction  or 
pressure,  although  occasionally  produced  by  extreme  cold.    Wearing 

285 


286 


THE    HUMAN    FOOT 


of  improperly  made  shoes  is  the  prevailing  cause,  which  allows  the 
foot  too  much  space  or  expansion  to  move  about,  consequently  rubbing 
upon  some  uneven  spot  or  prominence  on  the  inner  sole.     Callosities 


Chart  No.  179 

Callouses   on   Sole. 


in  this  case  are  usually  very  large,  extending  over  the  part  subjected 
to  friction.  In  most  cases  the  sensitive  places  are  usually  found  at 
the  ball  of  the  great  toe,  lateral  surface  of  the  little  toe,  at  the  heel 


Chart  Xo.  180 
Kiro     Pad     for     Callous     on     Sole. 


and  over  the  heads  of  the  Metatarsal  bones.  Inflammation  is  not 
known  unless  when  infected.  Callosities  may  also  occur  as  a  result 
of  chronic  skin  diseases,  such  as  psoriasis,  eczema,  ichthyosis,  etc. 


CALLOSITIES— CALLOUS 


287 


Chart  No.  181 
Applying  Felt  Kiro  Pad  with  Cedar  Plaster. 


Chart  No.   182 
Finger   Pointing  to  Thick   Callous  Over   Second  and  Third   Metatarsals. 


288 


THE    HUMAN    FOOT 


Callouses  on  the  sole  are  most  prevalent  and  are  usually  caused 
by  pressure  and  Action  on  the  Metatarsal  heads  which  go  to  form 
the  Anterior  Traii<"*erse  arch.  At  this  point  the  protective  tissue  is 
very  light  and  the  parts  are  easily  irritated. 


1                                                             — 

k           .  o 

JNS 

mm  - 

Chart  No.  183 
Skived  Felt  Kiro  Pads  Used  for  Callouses. 


Callosities  on  the  heel  and  instep  are  not  as  a  rule  troublesome  and 
are  easily  cured  by  being  relieved  from  pressure  and  friction. 

Treatment. — The  treatment  consists  in  first  removing  the  cause, 
then  relieving  the  pressure  on  the  irritated  parts.     Examine  the  foot 


Chart  No.  184 
Rubber    Fad    for    Protecting   from    Pressure    Callouses   on   Bottom   of   Feet. 


carefully  to  learn  if  the  callouses  form  over  the  Metatarsal  heads ; 
fit  the  patient  with  a  pair  of  Anterior  Metatarsal  arch  supports  with- 
out the  flange  to  relieve  pressure  and  distribute  the  weight.  Where 
callouses  are  thick  and  of  long  standing  apply  pedico  callous  salve, 
using  absorbo  pads  or  kiro  pads  to  protect  and  remove  pressure. 


CHAPTER    XXXVII 


INGROWING   TOE   NAIL 

Ingrowing  Nail  is  a  condition  in  which  the  lateral  edge  of  a  nail  has 
become  imbedded  in  the  adjacent  soft  parts  of  the  lateral  nail  groove 
and  giving  rise  to  an  inflammation  of  the  matrix  and  soft  parts  about 
the  nail. 


Chart  No.  185 
Ingrowing  Toe  Nail. 


In  describing  a  nail  it  is  well  to  understand  that  the  nail  is  a  part 
of  the  epidermis,  which  consists  of  epithelial  scales,  which  are  modi- 
fied to  form  the  nail  cell  and  are  joined  together  in  a  horny,  elastic 
substance  to  give  strength  to  the  ends  of  the  toes. 

The  cells  of  the  nail,  like  those  of  the  epidermis  are  derived  from 
the  true  skin,  which  in  this  part  is  called  the  matrix  or  root  of  the 
nail.  The  cells  are  produced  at  the  root  of  the  nail  and  pushed  for- 
ward to  supply  wear  and  tear  at  the  end. 

19  289 


290 


THE    HUMAN    FOOT 


It  is  most  frequently  found  on  the  large  toe,  although  it  may 
appear  on  any  of  the  other  toes,  but  less  severely.  It  may  be 
caused  by  improper  cutting  of  the  nail,  or  by  the  "wearing  of  shoes 
too  narrow  across  the  toes,  which  force  the  flesh  against  the  sides 


Chart  No.  186 
Cut  of  Nail  Spring,  Etc. 


of  the  nails,  which  subsequently  causes  the  part  to  become  inflamed, 
swollen  and  very  painful.  Walking  increases  the  inflammation,  which 
may  result  in  ulceration  along  the  entire  nail  groove.  Under  im- 
proper treatment  or  negligence  it  will  continue  for  some  time  until 
the  whole  area  is  covered  with  proud  flesh.     The  pain  becomes  so 


INGROWING    TOE    NAIL  291 

severe  that  the  patient  cannot  without  much  pain  sustain  the  weight 
of  the  body  upon  the  foot  or  toe  and  is  compelled  to  rest.  All  pres- 
sure, such  as  pointed  and  narrow  shoes  or  stockings  occasion,  should 
be  removed;  also  the  irritation  caused  by  the  pressure  of  the  side 
of  the  nail.  The  latter  may  be  done  by  introducing  a  small  piece 
of  cotton  under  the  edge  of  the  nail  and  between  it  and  the  swollen 
parts  with  a  probe  or  a  pointed  piece  of  wood.  Surgical  treatment 
consists  of  removing  that  part  of  the  nail  creating  the  irritation. 

The  mechanical  treatment  consists  of  applying  a  sterling  silver 
nail  spring  to  the  inverted  parts  of  the  nail,  and  the  use  of  an  astring- 
ent and  healing  remedy  to  destroy  the  proud  flesh  and  create  a  healthy 
granulation  of  the  affected  area.  Then  it  is  very  important  to  re- 
move the  exciting  cause,  taking  care  to  protect  the  affected  parts  from 
pressure  of  any  nature,  and  to  wear  stockings  of  sufficient  length  and 
shoes  with  soft  and  wide  toes. 


OTHER    ABNORMAL    NAIL    CONDITIONS 

Onychauxis  is  a  condition  of  hypertrophy  in  which  the  nail  is 
overgrown.  It  may  be  in  the  dimensions  of  length,  thickness  or  width, 
or  all  combined,  and  is  accompanied  by  changes  in  color,  texture  and 
shape.  At  times  the  hypertrophy  is  lateral  and  the  condition  is  known 
as  ingrowing  nail,  and  causes  an  inflammation  of  the  surrounding  soft 
parts  (paronychia).  At  other  times  the  nail  becomes  bent  at  the 
distal  end,  due  to  the  excessive  growth,  and  is  known  as  onychogry- 
posis. 

Onychia  is  an  inflammation  of  the  matrix  of  the  nail,  and  is 
characterized  by  pain,  swelling  and  the  formation  of  pus  under  the 
nail.  The  nail  may  eventually  be  destroyed,  exposing  the  surface, 
which  is  highly  inflamed  and  suppurative. 

This  condition  may  be  produced  by  traumatic  causes,  syphilis, 
tuberculosis,  eczema  and  other  skin  diseases,  which  may  cause  pus 
infection. 

Syphilitic  Onychia  is  not  often  seen  on  the  toes,  and  is  usually 
accompanied  with  syphilitic   eruptions   on  other  parts   of  the  body. 


292  THE    HUM  AX    FOOT 

The  matrix  of  the  nail  frequently  turns  red;  there  is  swelling,  sup- 
puration and  ulceration.  The  entire  extremity  of  the  toe  becomes 
enlarged  and  the  skin  around  the  nail  becomes  swollen,  while  the 
suppuration  increases,  partly  overlapping  the  nail,  giving  an  appear- 
ance of  an  ordinary  ingrowing  toe-nail.  The  nail  also  may  become 
discolored,  brittle,  altered  in  thickness,  rough,  and  at  times  falls  off. 
The  local  affection  disappears  and  readily  yields  to  systemic  treat- 
ment. Sometimes  onychia  assumes  a  malignant  form,  causing  severe 
pain  and  destruction  of  the  Periosteum,  with  disease  and  perhaps 
necrosis  of  the  bone.  This  condition  may  occur  with  no  apparent 
cause  either  local  or  constitutional,  but  probably  is  a  result  of  mal- 
assimilation  or  some  other  bad  condition  of  the  parts. 


CHAPTER    XXXVIII 


SKIAGRAPHY 

The  use  of  X-rays  in  diagnosis  is  without  a  doubt  indispensable. 
They  are  the  means  of  locating  fractures  and  dislocations,  tumors, 
foreign  bodies  and  diseases  of  the  bones.     In  recognizing  internal  dis- 


Chart  No.  187 
X-Ray  Showing  Foot  with  Spreading  of  Trans- 
verse Anterior  Arch. 


eases  the  X-rays  have  proved  themselves  exceedingly  valuable  in  many 
instances,  and  again  facilitating  and  eliminating  many  of  the  dangers 
associated  with  the  same.     There  are  cases  in  which  from  the  nature 

293 


294 


THE    HUMAN    FOOT 


and  location  of  the  pain  a  true  diagnosis  can  be  made,  but  frequently- 
many  errors  occur.  Thus  what  heretofore  was  conjecture  is  now 
replaced  by  certainty,  as  the  X-ray  enables  us  to  obtain  a  perfect 
picture  of  the  existing  conditions. 


Chart  No.  188 

X-Ray  Same  Foot  in  Shoe.     Note  Crowding  of 

Metatarsals  as  well  as  Bones  of  Toes. 


As  the  radiograph  of  a  suspected  foot  aids  materially  in  diag- 
nosis, it  is  advisable  if  possible  to  obtain  one  before  a  positive  diagnosis 
is  made.  By  a  skiagram  many  obscure  cases  are  cleared  up.  A  poor 
one  is  worse  than  useless,  as  it  is  likely  to  mislead.  In  taking  a 
skiagram  of  an  abnormality  it  is  usually  necessary  to  take  two  or 
more  views  of  the  object  before  a  satisfactory  one  is  obtained.     A 


SKIAGRAPHY 


295 


fracture  may  not  show   from   one  side,   but  may  be   perfectly  clear 
from  the  front,  or  vice  versa.     To  note  possible  changes  which  may 


Chart  No.  189 

X-Ray  of  Child's  Foot, 

Normal. 


take  place  after  the  interval  it  may  be  necessary  to  repeat  the  skia- 
gram.    Diminished  density    (bone   rarefaction)    on  the   affected  side 


Chart  No.  190 
X-Ray  Showing  Foot  of  Woman,  Poised  for  High  Heel  Shoe,  with  Dropped  Metatarsals 

in  a  skiagram  denotes  the  beginning  of  a  bone  disease,  and  when 
the  bone  disease  recedes  the  skiagram  will  show  increasing  density 
before  the  improvement  is  evident. 


296  THE    HUMAN    FOOT 

In  taking  a  skiagraph  of  the  joints,  particularly  the  hip,  they  may 
appear  in  the  plate  to  be  ankylosed,  but  as  a  matter  of  fact  consid- 
erable motion  is  present.  Bony  ankylosis  can  be  proved  in  a  skiagraph, 
by  tracing  from  bone  to  bone  the  individual  striae  or  lines.  In  a 
skiagraph  of  arthritis  deformans,  lessened  joint  interval  (condensation 
of  cartilage),  bone  atrophy  and  probably  osteophytes.  In  cases  of 
a  dislocated  hip,  or  Coxa  Vara,  the  skiagraphs  are  usually  obvious.  It 
is  advisable  to  take  corresponding  parts  that  a  comparison  may  be 
made.  In  a  skiagram  of  a  diffuse  tuberculous  bone,  infiltration  is  not 
shown. 

In  order  to  make  proper  deduction  and  correctly  interpret  X-ray 
plates  the  operator  must  be  thoroughly  versed  in  surgery  and  par- 
ticularly familiar  with  the  anatomic  structure  of  the  body,  including 
centers  of  ossification  and  congenital  deviations. 


CHAPTER    XXXIX 


HISTORY  OF  FOOTWEAR 


Footwear  of  the  Ancients  B.  C.  53 — A.  D.  450. 

In  the  preparation  of  this  chapter  many  old-time  books  were  con-r 
suited  so  that  an  understandable  history  of  shoes  might  be  obtained. 

Shoes  were  no  doubt  the  result  of  necessity  to  form  some  means 
of  protection  to  the  feet,  but  in  later  years  were  used  more  exclusively 
for  the  style  they  afforded. 

The  ancient  Egyptians,  who  possessed  all  the  peculiarities  charac- 
teristic of  the  Xegro  conformation,  seem  to  have  gone  nearly  naked, 
and  in  many  representations  of  personages  of  both  sexes  the  whole 
upper  part  of  the  body  appeared  entirely  naked,  or  adorned  only  with 
a  profusion  of  necklaces,  belts,  armlets  and  bracelets,  while  an  apron 
wrapped  around  the  loins  descended  like  a  petticoat  to  the  ankle. 

The  Asiatics  often  wore  half-boots  laced  before  with  four  long, 
depending  flaps,  probably  formed  out  of  the  legs  of  the  animals  whose 
skins  were  converted  into  these  buskins. 

Eastern  personages  frequently  appear  in  shoes  or  slippers,  but 
seldom  if  ever  in  mere  sandals  that  leave  the  toes  bare  like  those 
worn  by  the  Greeks. 

In  the  Old  Testament  frequent  mention  is  made  of  shoes :  Thus 
God  commanded  Moses,  "Draw  not  hither;  put  off  thy  shoes  from  off 
thy  feet,  for  the  place  whereon  thou  standest  is  holy  ground." — Exod. 
III.  5.  It  is  known  that  to  this  day  the  Oriental  removes  his  shoes 
on  entering  his  house  of  prayer. 

In  the  books  of  Deuteronomy,  Joshua,  Ruth,  in  the  Psalms,  in 
Amos,  and  in  other  parts  of  the  Bible,  there  are  chapters  informing 
us  that  sandals  and  shoes  of  rushes  or  of  leather,  of  beautiful  work- 

297 


298 


THE    HUMAN    FOOT 


Roman    Buskin    Worn    from 
55  B.  C.  to  A.  D.  450. 


Greek  Sandal. 


^>>^ 


Gallo-Roman  Sandal. 


Greek  Sandal. 


^.Irt^•}.1^?<*•'>', 


Roman  Sandal. 


Chart  No.  191 


Bohemian  Child's  Shoe. 


HISTORY    OF    FOOTWEAR  299 

manship,  were  commonly  worn  by  the  Egyptians.  We  have  also 
ample  proof  by  the  splendid  examples  exhibited  in  the  Egyptian  de- 
partment of  the  British  Museum. 


Footwear  of  the  Greeks  and  Romans. 

Taking  a  long  stride  from  the  remote  to  that  of  the  Greek  and 
Roman,  and  later  to  the  medieval  era,  we  find  the  art  of  shoe  and 
sandal  making  continues  to  play  an  important  part  in  the  civilized 
world. 

The  feet  of  the  ancient  Greeks  frequently  were  left  entirely  bare, 
sometimes  protected  underneath  by  a  simple  sole  tied  with  thongs  or 
strings  disposed  in  a  variety  of  elegant  ways  across  the  instep  and 
around  the  ankle.  They  were  often  shielded  above  by  means  of  shoes 
or  half-boots,  laced  before  and  lined  with  the  fur  of  animals  of  the 
feline  tribe,  whose  muzzles  and  claws  were  disposed  in  front. 

The  Romans  had  a  great  variety  of  sandals,  the  greater  portion 
being  similar  to  those  worn  by  the  Greeks,  one  kind  covering  the 
whole  leg,  called  Ypodementa;  in  the  Greek  and  in  the  Latin  by 
several  names,  viz.,  calceus,  mulleus,  pero  and  phsecosium. 

Another  variety  known  covered  only  the  sole  of  the  foot,  and 
were  made  of  leather  or  other  materials.  These  were  called  by  the 
Greeks  pedita,  but  were  demonstrated  in  various  ways  by  the  Romans 
as  caliga,  solea,  campagus,  baxea,  sandalium,  crepida  and  sicyonia. 
To  all  the  term  "calceus"  was  invariably  applied. 

A  shoe,  usually  of  a  scarlet  color,  but  sometimes  purple,  called 
"mulleus,"  was  forbidden  to  be  worn  by  the  common  people. 

The  phaecosium,  a  light  thin  shoe,  was  worn  by  the  priests  of 
Athens  and  also  by  the  Romans.  It  covered  the  entire  foot  and  was 
made  of  leather. 

The  shoes  worn  by  the  people  of  ancient  Latium  were  made  of 
untanned  leather,  and  in  later  times  were  worn  by  the  rustic  people 
of  the  lower  classes.  This  type  of  shoe  was  called  the  "pero."  The 
campagus  and  the  caliga  were  sandals,  worn  by  the  military.  The 
sole  of  the  latter  was  large  and  strengthened  with  nails,  and  chiefly 


300 


THE    HUMAN    FOOT 


A  Wide-Toed  Shoe  of  Henry  the  VIII 
Time,  Without  the  Heel  Piece.  This  Fash- 
ion Prevailed  with  the  Military  in  the  Steel 
Soleret.  It  Measures  9  inches  in  Length 
and   6   inches  Across  the   Toes. 

Chart  No. 


A  Riding  Boot  or  Buskin. 
This  Undoubtedly  Belorge^ 
to    Queen    Elizabeth. 


192 


HISTORY    OF    FOOTWEAR  301 

appropriated  to  the  common  soldiers.  The  campagus  was  worn  by 
the  emperors  and  generals  of  the  army,  it  differing  little  in  form  from 
the  caliga,  but  the  ligatures  were  more  closely  interwoven  with  each 
other  and  were  more  often  crossed  over  the  foot,  producing  a  resem- 
blance of  network.  The  Emperor  Gallienus  wore  the  caliga  orna- 
mented with  jewels  in  preference  to  the  campagus,  which  he  scorn- 
fully described  as  nothing  but  nets. 

The  caliga,  the  crepida,  and  of  course  the  sandalium,  were  all  of 
these  species  of  sandals  fastened  about  the  feet  and  ankles  by  fillets, 
or  thongs,  but  though  each  had  its  peculiarities  it  is  at  this  late  date 
impossible  to  ascertain  them.  The  solea,  we  are  informed,  could  not 
in  strict  decorum  be  worn  with  the  toga,  and  it  was  considered  effemi- 
nate to  appear  in  the  streets  of  Rome  with  them.  However,  regard- 
less of  this  rule,  the  Emperor  Caligula  not  only  wore  the  solea  in 
public,  but  permitted  all  who  pleased  to  follow  his  example.  The 
baxea,  also  of  the  sandal  kind,  was  originally  worn,  according  to 
Arnobius  and  Tertullian,  by  the  Grecian  philosophers,  and  as  it  ap- 
pears from  the  former  author,  was  manufactured  from  the  leaves  of 
the  palm.  Here  Plantius  notices  the  baxea,  but  nothing  respecting 
their  form  is  specified.  Cicero  tells  us  the  sicyonia  was  used  in 
races,  and  from  this  we  infer  it  must  have  been  a  very  light  kind  of 
sandal. 

Lucian  speaks  of  it  as  being  worn  with  white  socks.  A  shoe  or 
sandal  called  the  "gallica"  was  adopted  from  the  Gauls,  but  was  for- 
bidden to  be  worn  with  the  toga,  and  to  these  may  be  added  the 
saulponese,  worn  by  the  country  people;  also  the  solea,  a  shoe  with 
soles  of  wood  called  in  Latin  solea  ligncc  (wooden  sole),  used  by  the 
poor. 

Of  household  words  which  occur  in  the  catalogue  of  Roman  foot- 
gear two  names  are  familiar,  the  sock  and  the  buskin.  The  sock,  or 
"soccus,"  as  it  was  called,  is  stated  to  have  been  a  plain  kind  of  shoe, 
amply  large  enough  to  receive  the  foot  with  the  caliga,  crepida  or  any 
other  kind  of  shoe  upon  it. 

The  buskin  (cothurnus)  was  anciently  worn  by  the  Phrygians  and 
the  Greeks,  deriving  its  reputation  from  being  introduced  to  the  stage 


302  THE    HUMAN    FOOT 

by  Sophocles  in  his  tragedies.  It  was  a  boot  laced  up  the  front  of 
the  leg,  at  times  covering  the  toes  entirely,  and  at  others  a  stay  passed 
between  the  great  toe  and  the  next  connecting  the  sole  with  the  upper 
portion,  which  met  together  over  the  instep  and  were  from  this  point 
laced  up  the  front  similar  to  half-boots  worn  at  present. 

The  cothurnus  was  worn  by  both  sexes  in  Rome,  as  they  were  in 
Phrygia,  but  from  the  circumstances  mentioned  above  it  has  especially 
been  associated  with  tragedy. 

The  soccus  was  worn  by  the  comic  actors  because  in  like  manner 
it  was  typical  of  comedy. 

Socks,  or  covering  for  the  feet  made  of  wool  or  goat's  hair,  called 
"udones,"  were  used  by  the  Romans,  but  the  men  who  wore  them 
were  regarded  as  effeminate. 

Painted  shoes  of  various  colors,  often  sumptuously  adorned  with 
gold,  silver  and  precious  stones,  were  worn  by  the  wealthy.  Em- 
peror Heliogabalus  had  his  set  with  diamonds  interspersed  with  other 
jewels. 

Emperor  Amelian  did  not  favor  painted  shoes,  considering  them 
too  effeminate  for  men,  and  therefore  prohibited  the  use  by  them  of 
the  mullei,  which  were  red,  white,  yellow  and  green. 

The  latter  he  called  "ivy  leaf  colored"  calcei  hidracei,  a  type  of 
shoe  turned  up,  and  with  pointed  toes  called  calcei  repondi,  or  bowed 
shoes,  a  fashion  adopted  from  the  East;  and  subsequently  carried  to 
such  extravagance  in  the  middle  ages. 

Black  leather  boots  reaching  from  the  middle  of  the  leg  are  said 
to  have  been  worn  by  the  senators  from  the  time  of  Casus  Marcus. 
(See  chart  No.  191.) 


Footwear  of  Anglo-Saxons. 

There  is  nothing  more  interesting  in  the  history  of  civilization 
than  the  varying  changes  in  dress  and  fashion. 

After  the  dissolution  of  the  Roman  Empire,  the  different  tribes 
who  settled  in  its  provinces  appear  in  general  to  have  adopted  the 
civil   costumes   of   the   conquered  Romans,   while   they   probably   re- 


HISTORY    OF    FOOTWEAR 


303 


A  Chopine  for  the  Right  Foot  of  Coarse 
Workmanship.  The  Sole  of  This  is  Made 
of  Layers  or  Blocks  of  Cork,  the  Center 
Being  Hollow. 


A  Wooden  Patten  Made  of  Two  Flat  Pieces  Overlap- 
ping in  the  Center  and  Hinged  with  Leather.  It  is 
10J/2  inches  in  Length  and  2  inches  at  the  Widest 
Part  of  the  Sole. 


A     Wooden     Patten     10  J4     inches     Long    and     33 
inches    at    Its   Widest.      Worn    During    14th   and    15th 
Centuries. 


A    14th    Century    Steel    Soleret    (Poulaine) 


An  Example  of  the  Extravagant  and 
Singular  Fashion  of  the  Shoes  of  the  14th 
Century. 


Chart  No.  193 


304  THE    HUMAN    FOOT 

tained  with  tenacity  the  arms  and  military  customs  of  their  fore- 
fathers. There  was.  a  general  resemblance  between  the  dress  of  the 
Anglo-Saxons,  the  Franks,  and  other  nations  of  the  West.  In  the 
manuscripts  the  form  of  shoes  as  represented  is  nearly  uniform.  They 
cover  the  foot  to  the  ankle,  are  tied  with  a  thong,  having  an  opening 
down  the  instep,  and  are  usually  painted  black,  except  those  worn 
by  the  princes  and  great  persons,  who  had  them  frequently  gilt  or 
covered  with  gold. 

Anglo-Norman  Footwear  1060-1200  A.  D. 

The  civil  costume  of  the  Anglo-Normans  at  first  did  not  differ 
widely  from  that  of  the  Anglo-Saxons,  their  shoes  being  almost 
similar.  Near  the  end  of  the  century  shoes  were  constructed  dif- 
ferently, being  profusely  ornamented.  Knights  and  people  of  fashion 
wore  long,  pointed  shoes,  which  were  often  turned  up  at  the  points. 

Long  pantaloons  with  feet  to  them,  with  shoes  or  sometimes  short 
boots,  were  worn  by  the  middle  or  lower  classes. 

Shoes  Worn  in  the  Thirteenth  Century. 

The  shoes  worn  in  the  Thirteenth  century  were  long-toed,  and 
among  the  rich  they  were  very  elaborate,  being  elegantly  embroidered 
in  fretwork. 

Shoes  Worn  in  the  Fourteenth  Century. 

On  the  character  of  the  costume  the  reign  of  Henry  VI.  has 
nothing  very  decided.  It  may  be  regarded  as  a  period  of  transition 
between  the  reign  of  Edward  I.  and  that  of  Edward  III. 

The  dress  of  the  male  continued  much  the  same  as  in  the  preced- 
ing reign,  except  that  near  the  end  of  this  reign  it  was  distinguished 
by  the  accumulation  of  finery  which  became  so  obnoxious  to  the 
reforming  lollards  in  the  latter  part  of  this  century.  It  appears  that 
many  fashions  of  this  reign  have  been  brought  from  Germany.  The 
footwear,  as  described  by  a  contemporary  writer  of  the  time,  is  thus : 


HISTORY    OF    FOOTWEAR  305 

"Their  shoes  and  patterns  are  snouted  and  piked  more  than  a  finger- 
long  bending  upward,  which  they  call  crakowes,  resembling  the  claws 
of  devils,  and  fastened  to  the  knee  with  chains  of  gold  and  silver." 
(See  Chart  No.  193.) 

Shoes  Worn  in  the  Fifteenth  Century. 

After  Henry  the  IV.  acceded  to  the  throne  various  attempts  were 
made  to  reform  the  extravagant  fashions  and  expensive  apparel  worn 
in  the  preceding  reigns,  severe  sumptuary  laws  being  repeatedly  en- 
acted, but  with  only  partial  success.  With  the  reign  of  Henry  VI. 
we  enter  a  new  period  of  the  history  of  costume. 

The  principal  characteristics  were  long,  tight  hose  with  feet,  and 
sometimes  short  boots  or  buskins,  after  boots  reaching  to  the  middle 
of  the  thigh  called  galoches ;  or  very  long-toed  shoes  with  high  fronts 
arid  backs  that  turn  over  each  way.  At  no  period  of  the  Fifteenth 
century  was  the  extravagance  of  dress  more  remarkable  than  during 
the  reign  of  Henry  VII.,  but  the  most  remarkable  characteristic  of 
the  latter  part  of  this  century  was  the  extreme  broadness  of  the  toes 
of  the  shoes,  which  suddenly  usurped  the  place  of  the  long,  pointed 
shoes  of  the  preceding  reigns. 

Paradin,  an  old  French  writer,  describing  the  manners  of  this 
century,  says  that  at  first  "Men  wore  shoes  with  a  point  before  half  a 
foot  long;  the  rich  and  more  extravagant  personages  wore  them  a 
foot  long,  and  princes  two  feet  long,  which  was  the  most  ridiculous 
thing  that  ever  was  seen;  and  when  men  became  tired  of  these 
pointed  shoes,  which  were  called  poulaines,  they  adopted  others  in 
their  places  which  were  named  duck-bills,  having  a  bill  or  beak  before 
of  four  or  five  fingers  in  length.  Afterward  assuming  a  contrary 
fashion,  they  wore  shoes  so  very  broad  in  front  as  to  exceed  the 
measure  of  a  good  foot." 

The  shoes  of  the  ladies  during  this  century  were  made  so  small  that 
they  could  hardly  walk  in  them,  frequently  causing  their  feet  to  be 
made  lame,  sore  and  full  of  corns.  This  condition  was  described  by 
a  French  moralist  as  being  "the  greatest  evil  of  the  age."     In  the 

20 


306 


THE    HUMAN    FOOT 


Shoes  of  Charles  the  First. 


0 


S 


^      .  3111  \k 

:;-"           .     3s§£     ^'f 

%i 

0  '               s>^S>j^-£       £?-  jj? 

/J* 

....  Ji2*Ssl»3 '  >  *'  ftp* 

A    Square    Toed    15th    Century    Black    Leather 
Shoe    Minus    the    Heel    and    Side    Leather. 


The    Left   Shoe  of  a  Handsome   White  Satin  A   Shoe  of  Elizabeth,   Queen  of  Bohemia,   17th 

Pair  which  Belonged  to  Queen  Elizabeth.  Century. 

Chart  No.  194 


HISTORY    OF    FOOTWEAR  307 

reign  of  Henry  VIII.  we  enter  upon  an  entirely  new  period  of  cos- 
tume and  art,  differing  in  every  possible  respect  from  the  preceding 
ages.  In  this  reign  the  former  splendors  of  the  feudal  baronage  were 
disappearing,  and  the  gorgeous  pageantry  of  the  Roman  church  was 
on  the  point  of  being  abolished ;  thus  it  was  in  this  century  under 
Edward  VI.  and  Mary  that  shoes  similar  to  those  of  the  present 
came  into  vogue.     (See  Chart  Xo.  194.) 

Tudor  Period,   Sixteenth  Century. 

During  the  Tudor  period  the  common  form  of  footgear  was  the 
low  shoe  with  a  big  Tudor  ribbon  rose.  Another  kind  of  shoe  for 
outdoor  wear  excited  the  merriment  of  those  who  held  aloof  from 
the  new  fashions  because  it  caused  the  wearer  to  shuffle.  This 
shoe  was  called  the  "pantofle,"  and  originally  was  a  much  plainer  kind 
of  shoe  to  be  strapped  over  the  other  as  a  protection. 

The  pantofle  was  a  modified  form  of  the  "chopines,"  being  worn 
in  Italy  at  this  time,  and  ladies'  high-heeled  shoes  in  England  were 
frequently  called  chopines.  Coryate  describes  the  Italian  chopine  as 
follows  :  "Of  a  great  height,  even  half  a  yard  high ;  and  by  how  much 
the  nobler  a  woman  is,  by  so  much  the  higher  are  her  chopines.  All 
their  gentlewomen,  and  most  of  their  wives  and  widows  that  are  of 
any  wealth,  are  assisted  and  supported  either  by  men  or  women  when 
they  walk  abroad,  so  that  they  may  not  fall." 

It  is  said  that  English  ladies  never  wore  any  such  absurd  articles, 
though  the  heels  to  their  slippers  were  extremely  high  and  unsuited 
to  pedestrian  exercise. 

There  were  in  vogue  more  comfortable  shoes,  and  one  of  the  Tudor 
princesses  had  black  velvet  buskins,  or  short  boots,  lined  with  fur. 
(See  Chart  No.  195.) 

Stuart  Period  of  the  Seventeenth  Century. 

Boots  appear  to  have  been  generally  worn  by  all  classes  of  society 
under  the  Stuarts,  and  thus  the  Spanish  Ambassador  Gondemar  said 
to  James,  "I  shall  amaze  my  countrymen  by  letting  them  know  at 


308 


THE    HUMAN    FOOT 


\ 


*-.*»***' 


f^M**'"1 


iW"" 


.;J-    ■•# 


A  Good   Example   of  the   15th   Century   Period, 

Pointed   or   Poulaine    Shoe   with    Strap 

for  Tying  It  Over  the  Instep. 


Examples    of    Broad    Toed    Leather    Shoes    of 
Early    16th    Century   Date. 


"A  Sole  of  a  15th  Century  Peaked  Shoe. 


t^^f***** 


^ 


jgTj  ■  W»wgg*g& 


'.--'.' 


A    Faixr   °f    Crimson    Morocco    Leather    Shoes,        A    Broad    Black    Leather    Toe    Piece    Pounced 
Worn   During  Middle   18th   Century.  and   Slashed.     It  Measures  5]/2   inches  Across. 

Chart  No    195 


HISTORY    OF    FOOTWEAR  309 

my  return  that  all  London  is  booted  and  apparently  ready  to  walk 
out  of  town." 

In  this  period,  at  the  beginning  of  the  Civil  War,  when  England 
was  divided  in  two  great  camps,  Royalists  and  Republicans,  the  Royal- 
ists, or  Cavaliers,  were  as  much  distinguished  from  the  Republicans, 
or  Roundheads,  in  their  dress  as  in  political  principle.  The  dress  of 
the  Cavalier  embodied  all  that  savored  of  graceful  ease  and  luxury. 
In  place  of  the  trunk  hose,  long  breeches  or  short  trousers,  which 
were  finished  off  with  ribbons  and  fringe  below  the  knee,  were  worn. 

Nearly  meeting  these,  came  the  boots  with  wide  ruffles  at  the  tops, 
which  were  often  the  cause  of  mishaps,  as  an  unlucky  gentleman 
remarks  :  "One  of  the  rowels  catched  hold  of  the  ruffle  of  my  boot, 
and  being  Spanish  leather,  and  subject  to  tear,  overthrew  me,  rends 
me  two  pair  of  silk  stockings,  that  I  put  on,  being  somewhat  of  a  raw 
morning,  a.  peach  color  and  another." 

This  proves  to  us  that  ruffles  were  made  of  leather  like  the  boot. 
It  must  have  been  much  finer  and  softer  to  admit  of  being  pulled  and 
fringed  out  at  the  edge,  as  was  commonly  the  case. 

Indoors  the  Cavalier  wore  what  was  more  becoming,  viz.,  low 
shoes  with  rosettes,  which  showed  the  smart  silk  stockings  to  ad- 
tantage.  Shoe  tyes  that  go  under  the  name  of  roses  cost  from  thirty 
shillings  to  three,  four  and  five  pounds.  Yea,  a  gallant  of  the  line 
not  long  since  paid  thirty  pounds  for  the  pair. 

The  dress  of  the  Puritans  was  very  sombre,  not  because  it  was 
imposed  on  them,  or  because  their  rank  and  position  made  luxury 
unseemly,  but  from  choice.  To  the  Puritan  all  adornment  was 
abhorrent,  beauty  a  curse,  and  luxury  a  crime.  The  boots  worn  in 
the  Cromwell  era  were  principally  made  of  Spanish  buff  leather. 
They  were  plain  to  ugliness,  and  were  armed  with  a  square  piece  of 
leather  in  front  to  keep  the  pressure  of  the  stirrups  from  the  instep. 

During  the  existence  of  the  commonwealth,  and  for  a  long  time 
after,  the  tops  of  the  boots  were  of  enormous  width. 

The  shoes  worn  during  the  reign  of  Charles  II.  and  James  II. 
were  distinguished  by  their  high  heels  and  long  toes  tapering  towards 


310 


THE    HUMAN    FOOT 


A  Chinese   Shoe  for  a  Child. 


An  Eastern  Shoe  Made  of  Hempen  Strings. 


An  Eastern  Pair  of  Wooden  Soled  Shoes. 


Wooden    Ch opine    or    Clog    Worn    by    Turkish 
Women.      This   is   8   inches   High. 


A  Lady's  Shoe  of  the  Middle  18th  Century. 


A  Turkish  Lady's   Slipper  Made   of   Green 
Leather. 
Chart  No.  196 


HISTORY    OF    FOOTWEAR 


311 


IN'  1 1 


Lady's    Shoe   of  the    18th    Century   Worn   with 
a  Clog. 


Jack-Boot   Worn   During  the    Cromwellian 
Period. 


A    17th    Century    Lady's    Shoe    of    Beautiful 

Workmanship,    Made    of    Crimson 

Morocco  Leather. 


xxgm 

i^^T*^.  *«■         Stoe  which  Belonged  to  King  Charles. 
"     "\--Jk 


17th   Century  Leather   Shoe 


'An  18th  Century  Shoe. 


Chart  No.  197 


312  THE    HUMAN    FOOT 

the  points,  but  cut  square  at  the  ends,  the  uppers  of  which  not  only 
covered  the  instep  but  extended  far  over  the  shins  of  the  wearer. 

Women  of  all  degrees  appear  from  the  pictures  we  see  to  have 
indulged  in  high  heeled  shoes.  Even  a  country  lass,  with  her  short 
skirt  and  basket  on  her  arm,  was  perched  up  on  heels  which  would 
not  disgrace  a  fashionable  bootmaker  today. 

Sometimes  the  Puritan  women  wore  the  more  sensible  clog,  or 
what  was  similar  to  that  footgear,  strapped  across  the  foot,  and  keep- 
ing her  well  out  of  the  mud.  The  citizeness  of  the  richer  class  wore 
large  rosettes  on  her  shoes,  and  when  she  walked  would  hold  up  her 
gown  over  a  lace-trimmed  petticoat.  Shoes  of  Spanish  leather  laced 
with  gold  were  commonly  worn,  those  worn  by  the  men  of  fashion 
being  squarer  or  less  pointed  toes  with  huge  flaps  ornamented  with 
small  buckles,  the  heels  being  somewhat  higher  and  covered  with 
colored  leather. 

It  is  said  that  buckles  were  first  used  in  the  reign  of  William 
III.,  but  if  this  is  true,  how  is  it  that  the  brass  monument  of 
Robert  Attelath,  at  Lymm,  who  died  in  1376,  is  depicted  with  shoes 
having  buckles?  It  is  fair  to  say  that  some  are  disposed  to  believe 
that  the  buckles  worn  prior  to  William  III.  were  only  used  as 
ornaments. 

These  buckles,  worn  so  much  at  the  time,  were  very  costly,  and 
it  is  beyond  doubt,  from  the  fact  that  they  were  often  made  from  the 
most  precious  metals  and  studded  with  brilliants.  William  himself 
wore  high  jack  boots,  differing  slightly  in  form  from  those  of  his 
predecessors,  having  the  same  instep  guards  and  cut  as  ugly  as  can 
be  imagined. 

The  shoes  of  the  ladies  had  high  heels,  and  it  was  quite  common 
to  bridge  them  with  a  leather  clog. 

During  the  reign  of  George  I.  and  II.  the  high-cut  quarter  shoe 
was  continued  to  be  worn  by  men,  red  being  the  fashionable  color 
for  the  heels,  and  adorned  with  buckles  of  large  dimensions.  The 
shoes  worn  by  the  ladies  were  much  handsomer  than  those  worn  by 
their  immediate  predecessors,  the  ugly  square  toes  having  been  super- 
seded by  toes  less  broad  and  more  sightly. 


HISTORY    OF    FOOTWEAR 


313 


North  American  Moccasin. 


U 

*  4 


An  Indian  Child's  Shoe. 


".'■Uy.Si^ 


A  Brown  Leather   Shoe  with  Double  Latchets, 

Crossing     Extremely     High     Instep     Flaps 

and  Fastening  at  the   Sides  by  Means 

of    a    Button    and    Hook. 


African    Sandal   of  Niger   River   District.      The 

Ringed  Receptacle  for  the  Great  Toe  is 

a   Feature   in  the   Sandal. 


African    Sandal   of  Plain   Character. 


A    Sandal    from   the    Niger   Rh-er   District. 
Chart  No.   198 


314 


THE    HUMAN    FOOT 


17th    Century   Shoe. 


A  Beautiful  Shoe  of  the  18th  Century  Made  of 
Crimson    Velvet    Embroidered    with    Gold. 


17th    Century    Lady's    Shoe. 


A    Common    Every-Day    Leather    Shoe    Worn 
_  During  the  17th   Century. 

Chart  No.  199 


HISTORY    OF    FOOTWEAR  315 

The  clog  worn  was  also  improved  by  having  the  heel  sunk  to 
receive  the  heel  of  the  shoe.  The  uppers  were  cut  from  silks  and 
satins,  and  were  richly  embroidered.  The  heels  of  these  shoes  were 
made  of  wood,  covered  with  silk,  satin  and  fancy  leather.  With  the 
advancement  of  time  shoe  quarters  were  cut  lower  and  the  heel 
"brought  more  forward. 

The  short,  varying  shoes  worn  by  the  ladies  came  into  vogue  in 
the  year  1790,  and  were  of  necessity  low  in  the  quarters,  and  they 
scarcely  had  any  heel. 

Shoes  with  buckles  lasted  to  the  commencement  of  the  present 
period  or,  rather,  revived  at  that  time. 

They  were  speedily  succeeded  by  shoes  fastened  with  strings.  The 
buckle  makers,  being  nearly  ruined  by  this  new  mode  in  shoes,  peti- 
tioned the  then  Prince  of  Wales  to  prohibit  the  wearing  of  shoe- 
strings in  favor  of  buckles,  but  his  readiness  to  oblige  the  petitioners 
did  not  materially  serve  them. 

In  the  reign  of  George  III.  close  fitting  top-boots,  the  legs  of 
which  were  cut  from  grained  leather,  were  very  commonly  worn,  the 
upper  portion  being  cut  to  resemble  the  form  of  the  leg,  and  it  was 
finished  with  a  turnover,  or  a  top,  as  it  was  afterward  called.  Boots 
not  so  high  were  difficult  to  get  on  or  off  and  in  the  process  of  time 
the  height  of  leg  was  lowered.  In  many  of  these  boots  the  turnover 
reached  down  to  the  ankle.  It  was  during  this  reign  that  the  Hessian 
came  into  fashion,  conceded  to  be  the  handsomest  boot  ever  worn. 

This  boot  was  a  German  importation,  but  boots  cut  similar  to  this 
were  known  to  have  been  worn  in  Bohemia  as  early  as  1700.  This 
was  followed  by  the  Wellington. 

In  the  reign  of  George  IV.  the  boots  worn  by  the  ladies  were 
laced  up  the  front.  Side  lacings  revived  in  that  of  the  succeeding 
monarch,  and  the  "Adelaide'"'  boot  took,  its  name  from  William's 
consort.  Sandalled  slippers  were  also  worn  and  remained  in  fashion 
to  the  early  portion  of  Queen  Victoria's  reign. 

Ribbons  for  shoestrings  were  commonly  employed  at  this  period. 

The  cut  of  the  quarters  has  since  undergone  many  changes,  mili- 
tary laced  boots  having  become  quite  common  for  ladies'  wear.     There 


316 


THE    HUMAN    FOOT 


Walking  Shoe  with   Rubber  Heel. 


Blucher   Oxford. 


Fancy  Cloth  Top  Button  Boot.  Patent   Leather   Dress   Pump. 

Chart  No.  200 


HISTORY    OF    FOOTWEAR  317 

was  an  interval  when  the  high  heel  was  superseded  by  the  low,  roon 
after  the  high  heel  again  asserted  itself,  and  has  remained  popular 
to  the  present.  Blucher  shoes,  which  came  into  fashion  in  the  early 
part  of  the  Eighteenth  century,  continued  in  favor  down  to  a  very 
recent  date,  and  are  not  yet  entirely  displaced.  The  modern  shoes  are 
now  constructed  on  more  hygienic  lines,  yet  with  a  great  variety 
of  patterns,  with  variations  in  material.     (See  Chart  No.  200.) 


CHAPTER    XL 


FOOTWEAR   AND    FITTING   OF   SHOES 

In  the  preceding  chapter  we  have  given  a  general  history  of  shoes 
and  footwear  up  to  the  present  century,  and  if  this  general  history  is 
carefully  read  it  will  be  seen  why  and  how  shoes  are  the  principal 
cause  of  mechanical  disturbances  of  the  normal  foot.  It  is  shown 
that  from  the  early  ages  considerable  thought  was  given  to  style  and 
fads  rather  than  to  the  scientific  requirements.  This  subject  has 
been  discussed  in  various  publications,  but  the  writers'  opinions 
differ  as  to  the  fitting  of  the  shoe,  the  construction  of  the  last,  and  the 
size  and  height  of  the  heel  because,  generally  speaking,  their  deduc- 
tions were  based  on  the  consideration  of  the  perfectly  normal  foot. 

My  belief  is  that  the  feet  of  today — the  feet  that  are  fitted — are  the 
ones  to  be  considered,  and  these  considerations  should  be  governed 
by  the  size  and  shape  of  the  foot,  the  style  of  the  shoe  desired 
by  the  shoe  patron,  the  style  and  pattern  of  shoe  the  patron  had  pre- 
viously worn,  and  the  pliability  and  general  condition  of  the  foot. 

In  order  to  understand  the  subject  thoroughly,  it  is  first  necessary 
to  know  of  the  general  construction  of  the  shoes  of  today,  the  meas- 
urements over  which  they  are  made,  sizes,  etc.,  which  will  be  given 
in  the  following  chapters. 

Measurements  of  Last — The  foundation  and  principle  in  shoe 
making  is  founded  on  the  measurements  and  the  wood  put  into  t he- 
last  or  form  over  which  the  shoe  is  made.  All  last  makers  tell  us 
that  the  fixed  standard  of  measurements  and  sizes  are  carefully  fol- 
lowed out  regardless  of  the  style  or  shape  of  last  to  be  constructed 
Thus,  if  this  is  true,  the  proportions  while  differing  in  shape  are  still 
of  the  same  basic  measurements.  Now  this  would  not  necessarily 
mean  that  the  shoe  produced  over  a  size  6E  on  one  style  of  last 
would  fit  the  same  foot  made  in  the  same  measurements  with  dif- 
ferent   shaping   of   the    wood.     For   this    reason   the    student    should 

318 


FOOTWEAR    AND    FITTING    OF    SHOES 


319 


qualify  by  knowing  the  foot  and  last  measurements,  and  study  the 
conditions  of  the  foot  to  be  fitted. 

The  following  are  measurements  adopted  in  the  U.  S.  A.  by  the 
National  Association  of  Retailers  for  standard  shoe  lasts: 


Standard  Shoe  Last 

MEN'S 

Measurements 

Sizes 

6 

6h 

7 

7| 

8 

8i 

9 

% 

10 

m 

11 

Hi 

9! 

12 

fBall   .... 

76 
'  8 

71 

8 

8! 

81 

81 

8! 

81 

m 

81 

9 

91 

A  J  Waist    . . 

n 

7% 

71 

8 

8! 

81 

81 

8! 

81 

81 

85 

9 

9! 

I  Instep   . . 

m 

8| 

8| 

81 

8| 

81 

9 

9! 

91 

91 

9! 

91 

9% 

[.Heel    ... 

HI 

HI 

HI 

HI 

12 

128 

121 

121 

12! 

12| 

12f 

121 

13 

fBall   .... 

8 

8! 

81 

8| 

8t 

81 

81 

81 

9 

9! 

91 

91 

9* 

g  J  Waist    . . 

n 

8 

8* 

81 

81 

8! 

88 

81 

8? 

9 

9! 

91 

91 

I  Instep   . . 

8! 

81 

81 

8? 

9 

98 

91 

91 

9! 

91 

91 

91 

10 

[Heel    ... 

m 

11? 

12 

128 

121 

121 

12! 

■121 

12| 

12J 

13 

13! 

131 

fBall   .... 

81 

81 

8* 

81 

8R 

81 

9 

91 

91 

91 

94 

91 

f9l 

q    1  Waist    . . 
I  Instep    . . 

8S 

81 

8| 

8f 

81 

81 

87 

°8 

9 

9! 

91 

92 

9! 

91 

8« 

°8 

81 

9 

9R 

91 

91 

9! 

91 

9£ 

91 

10 

10! 

101 

|_Heel    ... 

12 

128 

121 

12| 

12| 

1^1 

121 

121 

13 

13| 

131 

131 

13| 

fBall   .... 

8! 

81 

81 

81 

9 

9i 

-*8 

91 

91 

Q4 

91 

91 

91 

10 

j)  J  Waist    . . 

83h 

8! 

81 

81 

81 

9 

91 

78 

91 

Q3 

9! 

91 

9% 

91 

]  Instep    . 

9 

9* 

n 

y* 

9! 

91 

Q6 
"8 

91 

10 

10! 

101 

101 

10! 

1  Heel    ... 

12| 

121 

12| 

12| 

121 

125 

13 

13! 

131 

131 

13! 

131 

13| 

fBall   .... 

81 

81 

9 

n 

91 

91 

9! 

Q5 
-*8 

91 

01 

10 

105 

101 

E   1  Waist    . . 
1  Instep    . . 

8* 

81 

81 

9 

9! 

91 

91 

9! 

91 

91 

91 

10 

10! 

91 

n 

y* 

91 

9§ 

91 

10 

10! 

101 

101 

10! 

101 

101 

1  Heel    ... 

12| 

121 

12| 

121 

13 

13! 

13| 

131 

13! 

131 

13| 

13| 

14 

fBall   .... 

9 

9, 

91 

91 

91 

91 

91 

10 

1  Oh- 

101 

101 

10* 

p  J  Waist    . . 
1  Instep    . . 

85 

9 

9! 

91 

Q3 

-*8 

9! 

91 

91 

91 

io 

10! 

101 

101 

9! 

n 

y* 

% 

10 

10* 

101 

101 

10! 

101 

101 

101 

11 

iHeel    ... 

12| 

121 

13 

138 

131 

13| 

13* 

131 

131 

131 

14 

14! 

14| 

Standard  Shoe  Last 


LADIES' 


Measurements 


Sizes 

2£ 

3 

31 

4 

41 

5 

Si 

6 

61 

7 

fBall   ... 

61 

7 

71- 

71 

7\ 

7* 

'  8 

7s 

'  8 

71 

7T- 
'  8 

8 

A  -\  Waist    . 

61 

61 

7 

7! 

7% 

73 

'  8 

^ 

^ 

^1 

/I 

I.  Instep    . 

7% 

7! 

7\ 

76 
'  8 

71 

8 

8! 

81 

81 

8! 

fBall   ... 

7\ 

73 

71 

7i 

7% 

76 
'  8 

'8 

8 

8! 

81 

B  ]  Waist    . 

7 

7+' 

71 

73 

7% 

n 

76 

y* 

8 

8! 

L  Instep    . 

7s- 

'  8 

76 
'  8 

71 

8 

8! 

*i 

81 

8! 

88 

8* 

fBall   ... 

71 

71 

71' 

76 
'  8 

71 

'  8 

8 

8! 

81 

8| 

8! 

C  ■{  Waist    . 

7% 

7.3 

7* 

7* 

71 

n 

8 

8! 

81 

81 

1  Instep    . 

71 

8 

8£ 

8! 

8| 

81 

85 

8f 

84 

9 

320 


THE    HUMAN    FOOT 


Standard  Shoe  Last 

LADIES'— Continued 

Measurements 

Sizes 

21 

3 

3£ 

4 

4h 

5 

51 

6 

6h 

7 

f  Ball  . . . 

D   j    Waist.. 

1  Instep. . 

7\ 

n 

8SL 

7" 

'  8 

71 
81 

77 

71 

81 

8 

7| 

8| 

8 
81 

8| 
81 
8| 

8| 

8! 
8| 

8! 
81 
9 

81 
8| 

9s- 

81 
81 
9| 

f  Ball  . . . 

E  i   Waist.. 

L  Instep. . 

n 

7% 

81 

8 

71 

8| 

81 

8 

8| 

81 
8£ 

81 

81 
81 
81 

8| 
81 
9 

81 

8f 

98 

81 
81 

8J 
81 
91 

9 
8? 

9| 

Standard  Shoe  Last 


MISSES' 


Measurements 


Sizes 


A      fBa11     • 

A  -j  Waist 
L  Instep 

f  Ball    . 
B  4   Waist 

L  Instep 

fBall    . 

C  -i  Waist 

L  Instep 

.Ball    . 
-I  Waist 

Instep 

Ball    . 

2  «J  Waist 

Instep 


11 

111 

12 

121 

13 

131 

1 

11 

51 

ss 

6 

6* 

61 

61 

6* 

6f 

51 

si 

5* 

6 

61 

61 

6? 

6* 

61 

61 

6f 

6f 

6| 

61 

7 

71 

6 

61 

6§ 

6£ 

6* 

6| 

61 

61 

5* 

6 

61 

61 

61- 

6| 

61 

6  a 

61 

61 

61 

6| 

/ 

7i 
61 

7f 

7| 

6| 

6£ 

6^ 

61 

61 

7 

71 

61 

61 

61 

6* 

61 

6% 

6* 

7 

6| 

6| 

7 

H 

71 

n 

7f 

7f 

6i 

61 

61 

61 

7 

7\ 

7| 

7| 

6£ 

6f 

61 

6£ 

6* 

7 

7* 

71 

7 

71 

7| 

n 

7* 
'  1 

7\ 

7§ 

71 

61 

6J 

7 

7^ 

71 

71 

7f 

7% 

61 

61 

6* 

7 

7* 

71 

7f 

7% 

7\ 

71 

7| 

7| 

7| 

74 

8 

81 

7 
6\ 

n_ 

I* 
?* 
li. 

7i 
71 


71 
7i 


Standard  Shoe  Last 


BOYS' 


Measurements 


Sizes 

1 

u 

2 

21 

3 

31 

4 

41 

5 

51 

f  Ball    . . . 

6* 

61 

61 

63 

7 

7& 

71 

7i 

7% 

71 

A  J  }Va/st   • 

Instep    . 

6* 

61 

6| 

61 

6g 

7 

7S 

71 

7% 

7% 

7 

71 

71 

71 

7f 

71 

71 

71 

8 

K 

1  Heel    .  . 

10 

101 

101 

101 

lot 

10| 

101 

101 

11 

111 

f  Ball    . .  . 

6| 

61 

7 

71 

7|- 

7f 

7* 

7| 

71 

7' 

■d    J   W  aist    . 
D    1   Instep    . 

61 

61 

61 

7 

71 

71 

73 
'3 

7% 

71 

7\ 

71 

7| 

7* 

7f 

7| 

71 

8 

81 

81 

81 

1  Heel    . . 

10| 

101 

10| 

101 

1UJ 

101 

11 

111 

11! 

11! 

FOOTWEAR    AND    FITTING    OF    SHOES 


321 


Standard  Shoe  Last 


BOYS'— Continued 


Measurements 


Sizes 

1 

li 

2 

21 

3 

3i 

4 

4§ 

5 

5* 

f  Ball    .. 

7 

7| 

71 

71 

7* 

'  8 

7s 

76 

71 

8 

81 

q    1    Waist 

61 

7 

n 

71 

7a 

'  8 

7-5 

7« 

7| 

7\ 

8 

1    Instep 

n 

71 

71 

71 

8 

8* 

81 

81 

8| 

8f 

L  Heel    . 

10| 

10| 

10| 

101 

11 

HI 

HI 

HI 

HI 

HI 

f  Ball   . . . 

7| 

73 
'  8 

74 

'  8 

7| 

7& 

7-7 

8 

81 

8| 

8? 

jj   J    Waist 
1   Instep    . 

71 

'  8 

71 

'  8 

73 
'  8 

7% 

7| 

76 

'  8 

11 
'  g 

8 

81 

81 

7| 

71 

8 

81 

81 

81 

8| 

85 

°8 

81 

81 

L  Heel    . 

10| 

10| 

11 

HI 

HI 

HI 

lit 

HI 

HI 

Hi 

f  Ball   . . . 

7* 

7| 

76 

71 

8 

8| 

81 

81 

8* 

8| 

E   J    Waist 
]    Instep    . 

73 
'8 

7f 

7| 

7| 

71 

'  8 

8 

81 

81 

81 

81 

8 

81 

8| 

81 

8| 

8| 

81 

8S 

9 

91- 

1  Heel    . 

11 

HI 

HI 

HI 

Hf 

HI 

HI 

HI 

12 

m 

f  Ball   . . 

76 

7" 

'  8 

8 

81 

8f 

81 

8t 

81 

8! 

81 

F 

Waist 

7f 

7| 

n 

8 

8J 

81 

81 

81 

8| 

81 

Instep 

8| 

81 

st 

81 

8| 

8? 

9 

9* 

91 

91 

I  Heel    . 

HI 

HI 

in 

Hi 

HI 

in 

12 

12| 

121 

12| 

Standard  Shoe  Last 


YOUTHS' 


Measurements 


E 


Sizes 


Ball   .. 
Waist 
Instep 
Heel    . 


Ball   .. 
Waist 
Instep 
Heel    . 


Ball    .. 
Waist 
Instep 
Heel    . 


Ball  .. 
Waist 
Instep 
Heel    . 


Ball   .. 
Waist 
Instep 
Heel    . 


Ball   .. 
Waist 
Instep 
Heel    . 


C    6 

C22 
3  S  2 
73  0 
'32 


CIS 

J32 

Ci.4 

D3  2 
C3  0 

^  :>.  :> 


58  6 

J3  2 

511 
6  A 
811 


6ft 

C3  0 
J3  2 

Us  2 


U32 
63V 

611 
811 


8* 


6H 
611 
63ft 

u3? 
QJL 
-'3  2 


=U3 

J32 

5ft 
5SI 

8ft 


5Si 
511 
63*2 


Sal 
5§2 
6ft 
841 


6ft 
6ft 
641 


6JI 
6ft 
6§§ 

9ft 


6ii 

611 
7ft 

9ft 


C24 
J3  2 

5|°2 
6ft 
811 


6 

C28 
J32" 

6J-I 


6ft 
6ft 

612- 


6J| 

65; 
9,* 


6|f 
611 
7ft 
9!I 


53§ 
5^§ 
5Si 


511 
63^ 


6ft 
511 

6M 


611 
6ft 
611 


6il 
6SI 

9372 


611 

6§i 

7ft 
9JI 


10 


cao 

D32 
C26 

J3J 

u3  2 


6ft 
6ft 
61-1 


611 
611 
611 
9ft 


611 

611 

7_8- 
'32 

9xft 
y3% 


°32 
^26 

710 
'32 
Ql  8 


m 


11 


511 

5  Si 

63D2 

8sl 


6ft 

6i§ 

81i 


6ft 
6ft 
6S1 


655 
641 

63I 
9ft 


6SI 

6§i 
7ft 
941 


7ft 
6  SI 
741 
9Si 


51 
51 
61 


61 

6 

6-1 


6f 
61 


61 
6| 
7 
91 


74 
7 

7! 
91 


Hi 


6 

51 

6* 


6| 
61 
6f 


12 


64 


6f 
61 
6! 
9 


61 
6f 

61 
94 


61 
6f 
74 
9| 


71 
74 
71 
94 


61 
63 
71 
94 


74 

7 

7| 

9: 


71 
7| 

76 
'5 

10 


124 


61 


61 


61 
6f 
74 
9f 


7 

61 
71 
91 


7% 

7i 
91 


74 

'   8 

71 

71 

104 


13 


64 
6! 
6| 
9 


61 
61 
7 
91 


74 
7 

92 


7| 
7| 
74 
10 


71 


13i 


6f 
61 
64 
94 


61 

74 

9! 


7 

61 
71 
9f 


72 

'F 

7J- 

'  8 

7% 
91 


71 

71 

71 

101 


7| 
7| 


101    10f 


21 


322 

Standard  Shoe  Last 


THE    HUMAN    FOOT 
CHILD'S 


Measurements 


Sizes 


fBall    .. 
A  -I  Waist 
Llnstep 


fBall    .. 
B  4  Waist 
Llnstep 


fBall    ., 
C  A  Waist 
Llnstep 


fBall    . 

D  4  Waist 

Llnstep 


fBall    .. 
E  -i  Waist 
Llnstep 


41! 

411 


•5-*- 

^32 

5U 


SB 
514 


eon 

J32 

6 


C2S 
J3  2 
C2fi 

OiT5 


4|* 
411 
544 


5372 

5& 

541 


C15 
032 

541 

515 


Sli 
514 


5§4 
511 
644 


7 


5r3 

5 

5H 


cio 

«*  3  2 

C22 
•JS5 


KSA 
^3  2 

J3  2 
6-6- 


6  A 

6 

6M 


74 


53% 

5^2 

541 


541 
544 
5§i 


514 
548 
6& 


511 
5ii 

6a95 


6352 
641 


5-8- 

J3  2 

J3  2 
C20 
Jffl 


■Jig 

°32 
C14 
°3  2 

C2S 


C24 

C2  2 
°3  2 

6A 


Can 

J35 

641 


84 


5392 
511 


541 
545 
514 


5U 
6372 


6332 

6^ 

643 


644 

6392 

611 


•j  3  2 
J  3  2 

C2R 

Js5 


5|| 
5!§ 
6A 


63% 
6A 
641 


6H 

05-5 


9* 


545 
541 
511 


5§i 
511 
6^2 


6& 
514 

64! 


63°2 
6372 

614 


645 
64i 
611 


10 


C2(1 
35  2" 
Cl  8 
°3"2 

6 


C28 

J3  2 
C2fi 
->3^ 

6A 


6ft 
6ft 
641 


641 

641 
611 


6|| 
64  § 

7 


104 


511 

514 
6ft 


5§4 
5§1 
644 


6ft 
6ft 
641 


641 
641 
615 


611 

614 

7332 


These  sizes  are  divided,  for  the  convenience  of  the  student  inter- 
ested in  shoe  fitting-,  into  the  following  classes.  They  show  also  the 
measurements  and  lengths  of  the  various  sizes  by  inches. 


Infants'  Sizes  0  to  5 

Size  0  measures  in  length  4      inches. 

Size  1  measures  in  length  4^  inches. 

Size  2  measures  in  length  A2/s  inches. 

Size  3  measures  in  length  5       inches. 

Size  4  measures  in  length  5l/i  inches. 

Size  5  measures  in  length  S2/$  inches. 


Children's  Sizes  Run  from  Sizes  6  to  8 

Size  6  measures  in  length  6  inches. 
Size  7  measures  in  length  6l/i  inches. 
Size     8  measures  in  length  62/s  inches. 


Children's  Sizes,  Second  Run,  9  to  11 

Size  9  measures  in  length  7  inches. 
Size  10  measures  in  length  7T/3  inches. 
Size  11  measures  in  length  72/z  inches. 


FOOTWEAR    AND    FITTING    OF    SHOES  323 

Youths'  and  Misses'  Sizes,  12  to  2 

Size  12  measures  in  length  8      inches. 

Size  13  measures  in  length  8^  inches. 

Size     1  measures  in  length  8^3  inches. 

Size    2  measures  in  length  9      inches. 


Boys'  Sizes,  iyz  to  5 

Size  2y2  measures  in  length    9j4  inches. 

Size  3      measures  in  length    9Vz  inches. 

Size  4      measures  in  length    92/z  inches. 

Size  5      measures  in  length  10      inches. 


Women's  Sizes  2  to  8 

Size  2  measures  in  length  9  inches. 
Size  3  measures  in  length  9T/s  inches. 
Size  4  measures  in  length  92/z  inches. 
Size  5  measures  in  length  10  inches. 
Size  6  measures  in  length  lOj/3  inches. 
Size  7  measures  in  length  10^  inches. 
Size  8  measures  in  length   11   inches. 


Men's  Sizes  6  to  12 

Size  6  measures  in  length  10j^  inches. 
Size  7  measures  in  length  lO^  inches. 
Size  8  measures  in  length  11  inches. 
Size  9  measures  in  length  II3/3  inches. 
Size  10  measures  in  length  11^  inches. 
Size  11  measures  in  length  12  inches. 
Size  12  measures  in  length  12^  inches. 


The  above  measurements  in  length  are  the  measurements  at  the 
ball,  waist  and  heel.  These  are  the  principal  measurements  to  be 
considered. 


324 


THE    HUMAN    FOOT 


METHOD     OF     MEASURING    THE     FOOT    FOR    FITTING 
READY-TO-WEAR  SHOES 

The  equipment  for  shoe  fitters  is,  first,  the  standard  measurement 
stick,  a  rule  showing  the  measurements  in  inches  and  the  measure- 


Chart  No.  201 
Illustrating  Measurements  and  Manner  of  Taking  Measurements. 


ments  of  shoes  in  sizes  given  on  the  top  surface  of  the  rule.  As  an 
adjunct  a  shoemaker's  measuring  tape  should  be  used.  (See  Charts 
Nos.  202  and  203.) 


Chart  No.  202 
Standard  Measurement   Stick   for    Shoe   Fitters. 


The  present  method  of  shoe  fitting  and  measurements  is  based 
principally  on  the  length,  and  the  fitting  of  the  shoe  in  Avidth  is  left 
to  the  discretion  and  good  judgment  of  the  fitter.  The  shoe  dealer 
or  shoe  fitter  who  has  had  sufficient  experience  can  usually  recognize 


FOOTWEAR    AND    FITTING    OF    SHOES 


325 


the  width  of  shoe  by  the  appearance  of  the  foot,  with  the  help  of  the 
measurement  of  the  length  of  foot  on  the  measuring-  stick. 


Chart  No.  203 
Shoemaker's    Measuring   Tape 


The  measuring  of  the  length  in  fitting  shoes  is  very  important, 
because  more  malformations  and  deformities  are  caused  by  shoes 
fitted  too  short,  than  by  those  fitted  too  narrow  or  too  wide. 


Chart  No.  204 
Foot   Being  Measured  without  Weight  on. 


The  foot  is  placed  on  the  measuring  stick  and  the  weight  of  the 
body  borne  on  it.  The  reason  for  this  is  to  allow  for  the  natural 
expansion  of  the  normal  foot  and  the  elongation  of  the  abnormal, 
weakened  or  flat-foot,  so  as  to  still  allow  sufficient  length  to  the  foot 
in  the  standing  upright  position. 


326 


THE    HUMAN    FOOT 


Practically  all  feet  expand  slightly  when  the  weight  of  the  body 
is  placed  upon  them.  The  natural  expansion  should  not  be  over 
one-sixteenth  to  one-quarter  inch.  If  there  is  more  elongation  present 
it  is  due  to  weakness  of  the  Longitudinal  arch,  allowing  the  foot  to 
spread  and  elongate. 

When  the  foot  is  measured  with  the  weight  upon  it,  an  allowance 
of  one  and  one-half  to  two  and  one-half  sizes  for  proper  length  should 
be  made.  In  other  words,  the  length  of  shoe  selected  should  measure 
that  much  longer  than  the  entire  length  of  the  foot  in  a  standing 
position. 


Chart  No.  205 
Same  Foot  Measured  with  Weight  on,  Showing  Elongation  of  One  Full  Size. 


Any  disturbances  of  the  foot,  such  as  deformed  toes,  ingrowing 
toe-nails,  weakened  transverse  arch,  weakened  longitudinal  arch, 
broken-up  arch,  can  be  traced  directly  to  the  wearing  of  short  shoes. 
Bunions,  enlarged  joints,  crooked  toes,  can  also  be  traced  to  short 
shoes. 

Now,  as  regards  to  what  constitutes  a  good  fit,  the  following  rules 
should  be  carefully  carried  out :  First,  the  correct  length,  one  and  one- 
half  to  two  and  one-half  sizes  longer  than  the  actual  measurement, 
of  the  foot;  second,  width,  sufficient  width  at  the  ball  to  allow  for 
the  natural  spread  of  the  foot  at  that  point  without  compressing  the 
foot ;  third,  a  snug  fit  through  the  heel  and  instep ;  fourth,  if  a  lace 


FOOTWEAR    AND    FITTING    OF    SHOES  327 

shoe,  the  top  stay  should  not  come  close  together,  but  expanding 
enough  to  permit  of  enough  space  to  enable  one  to  draw  the  top  or 
instep  of  the  shoe  snug  without  meeting.  Care  should  be  taken  in 
the  selection  of  a  shoe  so  as  to  allow  a  sufficient  space  over  the  toe 
cap  or  seams  to  prevent  restriction  to  foot  action.  The  style  of  heel 
must  depend  upon  the  customer  or  patient,  and  the  style  of  heel  pre- 
viously worn  must  be  taken  into  consideration.  Women  who  have 
habitually  walked  on  high  heels  should  be  permitted  to  continue  to 
wear  them  unless  the  change  is  made  by  very  small  degrees. 

If  a  foot  poised  for  a  high  heel  is  put  into  a  low  heel  shoe,  you 
disturb  the  balancing  of  the  whole  body,  to  say  nothing  of  what  it 
will  do  to  the  foot;  but  remember  that  a  great  many  disturbances, 
nervousness  and  other  conditions  result.  The  poise  of  the  foot  ac- 
customs itself,  and  the  ligamentous  and  muscular  attachments  are 
likewise  adjusted  to  that  poise. 

In  the  fitting  of  shoes,  and  in  the  correction  of  foot  troubles,  it  is 
necessary  to  take  into  consideration  the  fact  that  nearly  everyone 
has  deformed  feet  as  a  result  of  improper  shoes  since  childhood,  and 
after  they  have  reached  an  age  in  life  where  development  is  com- 
pleted it  is  quite  difficult  to  make  any  alterations  in  the  skeleton  of 
the  foot.  This  is  a  very  broad  and  useful  rule  and  understanding  to 
have  in  shoe  fitting,  and  in  the  selection  of  footgear  for  corrective 
purposes. 

The  flat  heeled,  broad  toed  type  of  shoe,  and  the  extreme  patterns 
of  corrective  shoes  following  the  theory  of  Meyer  in  drawing  a  straight 
line  through  the  center  of  the  heel  to  the  center  of  the  great  toe, 
cannot  be  thoroughly  depended  upon  as  good  fitters  for  reasons  previ- 
ously stated.  Therefore,  shoes  should  be  constructed  over  lasts  de- 
signed on  anatomical  principles  constituting  a  perfectly  normal  foot. 
And  while,  in  so  doing,  one  is  carried  a  considerable  distance  from 
the  present  day  type,  that  construction  will  permit  nature  to  assert 
herself.  Shoes  having  a  straight  or  nearly  straight  inside  line  are 
preferable. 

There  is  probably  no  factor  so  important  in  the  causation  of  foot 
weakness  and  disturbances  as  that  of  the  shoe.     Shoe  fitters  and  shoe 


328 


THE    HUMAN    FOOT 


salesmen  and,  clerks  in  retail  stores  should  be  posted  on  the  mechan- 
ical construction  of  the  foot,  which  has  been  thoroughly  discussed 
in  the  preceding  chapter.  They  must  understand  that  there  are 
various  types  of  feet,  those  having  high  arches,  low  arches,  the  long, 
slender  foot,  the^  short,  wide  foot,  and  the  feet  that  are  abnormally 
thick  and  abnormally  thin,  in  large  and  small  sizes.  Then,  one  must 
know  the  elastic  movements  of  the  foot,  and  what  is  required  in  dif- 
ferent ages  and  in  different  occupations  and  climates,  and  it  has  been 


Chart  No.  206 
Showing  Meyer's  Line. 


proved  time  and  again  that  the  requirements  of  the  foot  are  different 
at  different  ages.  In  infancy  the  foot  is  broad  at  the  toes  and  narrow 
at  the  heel,  and  the  bones  are  soft  and  tender.  It  is  at  this  period 
that  the  foot  is  growing  rapidly,  and  like  all  other  organized  bodies 
under  similar  circumstances,  the  feet  are  very  easily  distorted  and 
injured  by  external  pressure.  Therefore,  at  this  age  great  care  must 
be  taken  so  that  the  child  arrives  at  maturity  free  from  deformity 
caused  by  ill-fitting  shoes.     I  am  glad  to  notice  that  within  the  past 


FOOTWEAR    AND    FITTING    OF    SHOES 


329 


ten  years  wonderful  strides  in  the  manufacture  of  children's  shoes 
have  been  made,  and  instead  of  crowding  the  foot  into  a  pointed  toe 
shoe  it  is  now  allowed  to  glide  into  the  orthopedic  shape  shoe,  leaving 
room  for  the  five  toes. 


Chart  No.  207 

A — Straight  Inside   Line   Shoe  with  Broad  Toe. 

I! — Straight  Inside  Line   Shoe  with  Modified  Toe. 

C — Broad    Toe    with    Swing   to    Outside,    Away    from    Straight    Inside    Line. 

D — Narrow  Toe   with    Swing  to   Outside,   Away   from    Straight   Inside   Line. 


Between  the  ages  of  nine  and  fourteen  extreme  care  must  be  taken 
in  fitting  children's  feet,  because  there  is  considerable  expansion  and 
growth  at  this  period,  and  but  very  little  thought  or  care  is  given  to 
the  feet  by  themselves.  From  the  age  of  fourteen  to  twenty-one 
years  the  foot  gradually  assumes  a  more  mature  form,  the  Tarsus 
becoming  thicker,  but  during  this  age  young  people  are  more  apt  to 


330 


THE    HUMAN    FOOT 


Chart  No.  208 
Foot  Thick  Through  Heel  and  Ankle,  with  Enlarged  Great  Toe  Joint. 


Chart  No.  209 
Foot  with    Low   Instep   at  Waist,   Otherwise   Normal. 


Chart  No.  210 
Foot  Showing  Normal  Arch. 


FOOTWEAR    AND    FITTING    OF    SHOES  331 

have  notions  of  fashion  and  style,  and  cramp  their  feet  into  narrow- 
toed  and  short  shoes. 

There  is  much  to  be  said  also  in  the  application  of  the  shoe  fitting- 
knowledge  to  persons  of  old  age.  The  foot  having  attained  its  ma- 
turity is  still,  however,  subject  to  changes  peculiar  to  organic  life, 
such  as  the  daily  waste  repairs,  and  wear  and  tear  from  exercise,  con- 
sequently provision  must  be  made  allowing  free  action  in  these 
respects.  It  is  in  older  age  that  muscular  weakness,  such  as  weakened 
foot  and  flat-foot,  develops. 

Then  again  provision  must  be  made  for  the  corpulent  men  and 
women,  where  there  is  rigidity  of  the  structure  of  the  feet  and  limbs, 
and  a  further  provision  must  be  made  for  occupations  requiring  per- 
sons to  be  long  hours  on  their  feet. 

If  feet  are  fitted  properly,  and  no  structural  weakness  exists,  there 
should  be  no  more  discomfort  to  the  feet  than  to  the  hands,  inde- 
pendent of  the  fact  that  the  body's  weight  is  carried  constantly  on 
them.  It  must  be  stated  that  the  mechanical  construction  of  the 
human  body  is  such  that  due  allowance  has  been  made  for  the  work 
imposed  upon  its  members. 

SUMMARY 

The  shoe  fitter,  then,  should  possess  the  necessary  qualifications, 
and  following  knowledge : 

First.  Knowledge  of  the  structure  of  the  human  foot,  bones, 
muscles,  ligaments   and  tendons. 

Second.     Be  able  to  recognize  abnormal  from  normal  feet. 

Third.  Be  able  to  detect  the  variations  in  feet,  and  intelligently 
assist  in  fitting  the  normal  foot  to  preserve  its  normal  condition. 

Fourth.  Abnormal  feet  should  be  carefully  examined  and  inquiry 
made  as  to  the  cause,  and  the  right  method  of  fitting  or  correcting  the 
cause  ascertained. 

Fifth.  To  know  from  symptoms,  such  as  callosities,  corns,  soft 
corns,  bunions,  etc.,  that  these  may  be  produced  by  slight  bone  dis- 
placements, and  to  have  the  correct  shoes  and  appliances  to  relieve 


332  THE    HUMAN    FOOT 

the   underlying  cause,  with   an   object  in  view  of  correcting  the   ab- 
normality. 

Sixth.  To  be  able  to  detect  the  weak,  flexible  foot  that  requires 
mechanical  aid,  and  a  knowledge  of  fitting  and  adjusting  appliances 
to  give  relief. 

Seventh.  To  have  a  knowledge  of  shoe  making,  of  modern  shoe 
construction,  and  be  able  to  judge  the  fitting  qualities  of  shoes, 
whether  they  are  extreme  fashions  or  modified  orthopedic  shoes,  and 
apply  the  right  shoe  on  the  right  foot. 

Eighth.  To  be.  able  to  recognize  abnormal  conditions  from  symp- 
toms easily  traced  by  the  manner  in  which  the  old  shoes  have  been 
worn. 

All  men  and  women  do  not  walk  in  the  same  manner.  They  do 
not  throw  or  roll  about  their  shoes  in  the  same  manner.  This  may 
be  caused  by  physical  defects,  weakness  in  the  muscular  control,  false 
positioning  of  the  structures,  and  also  due  to  occupations  in  the  varied 
walks  of  life.  Old  men  and  women  walk  considerably  different,  due 
to  the  general  declining  condition  of  the  tissues.  Tall  persons  walk 
with  a  different  stride  than  the  short,  stout  people.  Old  people  who' 
walk  with  their  heads  bowed  are  obliged  to  bend  the  knees  to  preserve 
their  equilibrium.  Women  who  have  always  worn  high  heel  shoes 
and  have  then  changed  to  low  heels  are  obliged  to  change  their  gait  to 
maintain  their  equilibrium.  "Women,  towards  the  end  of  pregnancy, 
walk  with  the  upper  part  of  their  frame  thrown  upward  to  maintain 
their  equilibrium,  which  changes  their  gait  in  walking.  Persons 
whose  shoes  are  short  make  indentations  in  the  inner  cap  of  the  toe 
of  the  shoe,  and  the  end  of  the  toe  of  the  sole  is  usually  stubbed  off. 
Persons  with  severe,  irritating  corns  throw  their  weight  on  the  heel 
so  as  to  avoid  pressure.  Persons  with  bunions,  enlarged  toe  joints, 
which  may  be  caused  by  weak  arch  or  flat-foot,  wear  their  shoes  to 
the  outside  in  an  endeavor  to  avoid  pressure.  Those  with  weak  ankle 
and  flat-foot  wear  off  the  inner  border  of  the  heels,  owing  to  the  over- 
balancing of  the  weight  on  the  inner  border  of  the  arch. 

Persons  having  Metatarsalgia  or  weakened  foot  in  the  anterior  arch 
spread  the  uppers  of  the  shoe  across  the  ball  of  the  foot  from  the  out- 


FOOTWEAR    AND    FITTING    OF    SHOES  333 

side  edge  of  the  sole,  and  will  irankly  admit  that  no  shoe  seems  to 
hold  its  shape. 

Women  having  arch  weakness  complain  of  slippers  and  low  shoes 
bulging  on  the  sides,  and  are  not  successful  in  securing  a  neat  fit. 
Slipping  at  the  heel  is  also  frequently  due  to  a  weakness  of  the  arch. 


CHAPTER    XLI 


HOSIERY 

This  is  a  very  important  subject  to  the  practitioner  of  mechanical 
orthopedics,  inasmuch  as  socks  and  stockings  have  a  vast  influence 
in  causing  disturbances  of  the  foot.  Indeed,  it  is  not  uncommon  to 
know  or  to  notice  cases  of  foot  distortions  due  primarily  to  pointed 
toe  and  short,  unyielding  stockings. 


Fig.  A 


Chart  No.  211 
X-Ray  Showing  Foot  in  Pointed  Toe  Hose  and  in  Toe  Free  Hose. 


A,    X-Ray    Showing   How   Ordinary    Stocking 
Crowds  the  Toes. 


B,    X-Ray    Showing   the    Same    Foot   in   Toe 
Free  Stocking. 


You  have  all  experienced  at  some  time  or  other  the  agony  of  being 
required  to  thrust  your  foot  into  a  stocking  possibly  of  wool  or  other 
material  which  had  been  badly  shrunken,  and  how  uncomfortable  and 
annoying  they  were  to  the  feet  until  by  actual  pressure  and  expansion 
created  by  the  foot  that  yielding  of  the  yarn  was  made  possible.  I 
have  frequently  noticed  this  in  my  practice  where  mothers  are  com- 

334 


HOSIERY 


335 


pelled  to  stretch  and  pull  the  stocking  in  order  to  be  able  to  draw  it 
over  the  infant's  chubby  foot  and  leg. 


No  Pressure  at 
Fifth  Toe. 


Cramped  Toes. 


Chart  No.  212 
Showing  Correct  and  Incorrect  Hose. 


Great  care  should  be  taken  from  the  first  wearing  of  socks  or 
stockings,  beginning  with  the  child.  For  children,  the  stockings  in 
summer  should  be  made  of  fine  white  cotton  or  silk,  or  silk  and  wool; 
then  in  winter  or  cold  weather  they  may  be  made  of  a  light  woolen 


336 


THE    HUMAN    FOOT 


fabric,  knit  flexible  enough  to  cling  to  the  foot  but  not  disturb  the 
natural  little  motions. 

Extreme  care  must  be  taken  in  having  the  stocking  sufficiently  long 
and  wide  at  the  toes.  It  is  true  in  the  infant  that  as  much  action  is 
given  to  the  toes  as  to  the  fingers,  and  these  little  motions  which 
mean  much  in  the  development  of  the  muscles  of  the  lower  limbs 


Chart  No.  213 
Digitated  Hose. 


should  not  be  interfered  with.  In  adults  the  result  of  the  early  wear- 
ing of  short,  pointed  toe  hosiery  may  be  found  in  such  distortions  as 
hammer  toes,  bunions  and  flat-foot.  In  practically  all  cases  of  struc- 
tural weakness  it  will  be  found  upon  careful  investigation  that  stock- 
ings have  contributed  their  destructive  work  through  interfering  with 
the  natural  motions  of  the  foot. 

Not  uncommonly  will  you  find  a  patient  well  fitted  in  two  shoes, 


HOSIERY 


337 


but  the  foot  actions  restricted  by  the  pointed  toe  short  hose.  Among 
women  this  is  very  common  where  the  combination  hose  supporters 
are  worn,  as  the  action  of  walking  and  body  motion  has  a  tendency 
to  draw  the  stocking  tight  around  the  foot  and  toes,  and  among  most 
women  and  children  the  action  of  walking  and  stepping  has  a  tendency 
of  drawing  the  stocking  tight  about  the  foot  as  one  would  work  the 
fingers  of  a  glove  over  the  hand. 


Chart  No.  214 
Hose  with   Compartment  for  Great  Toe. 


Again,  the  modern  way  of  knitting  hosiery  to  a  point  requires  the 
foot  to  labor  considerably  before  space  for  the  five  toes  has  been 
located. 

In  the  mechanical  treatment  of  hallux  valgus,  hammer  toes  and 
contracted  toes,  where  mechanical  treatment  has  been  resorted  to, 
extreme  care  must  be  observed  in  giving  advice  to  the  patient  as  to 
hosiery. 

22 


]38 


THE    HUMAN    FOOT 


Chart  Xo.  213  represents  a  digitated  hose,  affording-  a  separate  com- 
partment for  each  toe,  constructed  along  the  same  line  as  the  glove 
having  separate  fingers  for  the  hand.  This  permits  complete  mobility 
and  action  to  the  toes  and  the  muscular  attachments,  but  is  not  so 
practical  for  general  purposes,  as  an  extremely  wide  shoe  is  required 
to  permit  of  the  additional  space  necessary  due  to  the  double  layers 
of  materials  between  the  toes.  The  digitated  toe  stockings  are  indi- 
cated, however,  in  many  deformities  of  the  toes. 

Chart  Xo.  214  shows  a  very  practical  stocking,  which  is  constructed 
to  have  a  compartment  for  the  great  toe  only.     When  made  of  the 


Chart  No.  215 
A  Right  and  Left  Style  of  Hosiery. 


right  material  and  correct  shape,  permitting  space  for  the  remaining 
four  toes  without  hampering,  this  style  of  stocking  can  be  made  prac- 
tical use  of  in  bunions  or  dislocation  of  the  first  phalanx  of  the  great 
toe  and  is  especially  indicated.  It  is  also  very  useful  where  bunion 
right  or  toe  flex  devices  are  worn  to  support  the  great  toe  and  hold  it 
to  its  natural  position. 

Chart  No.  215  represents  the  right  and  left  style  of  stockings,  which 
are  very  practical  from  the  orthopedic  standpoint,  but  are  rather  diffi- 
cult for  the  person  wearing  them  unless  they  are  continuously  worn 
on  the  same  feet. 


HOSIERY 


339 


Chart  No.  216  represents  the  most  practical  and  ingeniously  de- 
signed stocking,  which  can  be  worn  with  a  greater  degree  of  comfort, 
and  have  the  greatest  prophylactic  value  in  preserving  the  natural 
movement  of  the  foot.  It  is  knitted  over  a  model  or  frame,  which 
permits  its  being  worn  on  either  right  or  left  foot,  and  being  quite 
nearly  square  with  only  sufficient  tapering  to  overcome  any  extreme 
fullness,  permitting  the  natural  toe  movements.     This  style  of  stock- 


Chart  No.  216 
Toe-Free  Hose. 


ing  has  been  used  by  the  author  in  his  many  years  of  practice  with 
success,  and  is  known  as  the  toe-free  hose.  I  am  sure  the  ortho- 
pedic practitioner  will  appreciate  the  many  advantages  and  the  wide 
range  of  usefulness  that  this  hosiery  will  command. 

In  the  X-ray  plates  (Chart  Xo.  211)  Fig.  A  indicates  the  ordinary 
stocking  or  sock  with  distorted  phalanx  while  Fig.  B  shows  an 
X-ray  of  the  toe-free  pattern,  indicating  perfect  freedom  of  the 
Phalanges. 


340  THE    HUMAN    FOOT 

Summary. 

The  stocking,  to  assist  in  foot  treatment,  should  then  consist  of : 

First.  One  made  of  a  smooth  weave,  free  from  wrinkles,  seams, 
etc. 

Second.  If  feet  are  tender,  toe  part  or  foot  of  stocking  should  be 
made  of  a  soft  undyed  yarn. 

Third.  Never  allow  fancy  dyed  hosiery  to  be  worn  by  persons 
having  any  skin  abrasions,  blisters,  excessive  perspiration  or  ten- 
derness. 

Fourth.  The  size  of  the  stocking  should  be  selected  according  to 
measurement.  In  men's  sizes  they  range  from  9^4  to  size  12.  The 
usual  size  markings  indicate  inches,  and  one-half  inch  should  be  added 
to  the  measurement  of  the  foot. 

Fifth.  When  the  stocking  is  on  the  foot  there  should  be  no  sen- 
sation of  pressure  about  the  toes,  and  the  length  from  heel  to  toe 
should  be  sufficient  to  permit  the  natural  expansion  of  the  foot  when 
the  weight  is  placed  upon  it. 

Sixth.  Don't  have  the  stocking  too  large  or  too  long.  Wrinkles 
will  form  and  blisters  may  result. 

Seventh.  The  stockings  must  be  kept  absolutely  clean.  They 
should  be  thoroughly  washed  with  warm  water  and  soap,  thoroughly 
rinsed  and  dried  in  the  sun.  A  clean  pair  should  be  worn  each  day. 
Where  stockings  are  not  washed  each  day  they  should  be  worn  alter- 
nately. 

Eighth.  Dusting  the  inside  of  the  stocking  with  an  antiseptic  foot 
powder  will  reduce  friction  and  act  as  a  disinfectant,  and  has  a  cor- 
rective action  on  the  skin. 


CHAPTER    XLII 


CARE  OF  THE  FEET 

As  considerable  comfort  and  pleasure  depend  on  keeping  the  feet 
in  a  state  of  health,  I  will  discuss  in  this  chapter  the  care  and  atten- 
tion feet  require.  From  the  time  shoes  and  stockings  are  first  worn 
care  and  attention  is  essential.  The  feet  should  be  washed  thoroughly 
with  a  good  antiseptic  soap,  the  granular  form  being  the  most  benefi- 
cial ;  they  should  then  be  wiped  and  thoroughly  dried,  particularly 
between  the  toes.  The  nails  should  be  cut  square,  and  not  often,  care 
being  taken  that  they  are  not  cut  below  the  top  of  the  toes,  as  they 
are  likely  to  result  in  onychia  (ingrowing  toe-nail). 

In  addition  to  washing,  the  feet  should  be  bathed,  this  being  neces- 
sary in  various  conditions  of  the  feet.  The  proper  and  most  con- 
venient time  is  at  night  just  before  retiring,  but  under  peculiar  cir- 
cumstances they  may  require  bathing  at  other  times  during  the  day. 

The  use  of  hot  or  cold  water  for  bathing  the  feet  depends  greatly 
on  the  difference,  and  constitution,  and  habits ;  thus,  for  persons  ad- 
vanced in  years  the  tepid  bath  is  preferable,  especially  if  they  are  sub- 
ject to  gout  or  rheumatism.  A  change  of  temperature  in  such  cases 
may  cause  serious  results,  and  this  treatment  is  to  be  deferred  while 
the  patient  is  suffering  from  either  of  those  disorders.  As  a  rule,  it 
is  not  advisable  for  old  people  to  bathe  the  feet ;  however,  great  com- 
fort may  be  derived  from  sponging  them  once  or  twice  a  week,  using 
a  granular  antiseptic  soap  and  warm  water,  which  will  soften  the 
scales  and  cuticle,  and  can  subsequently  be  rubbed  off  with  a  coarse 
towel. 

When  the  feet  become  fatigued  and  inflamed  after  a  day's  use,  they 
should  be  bathed  in  a  hot  antiseptic  solution  for  about  fifteen  or 
twenty  minutes.  As  soon  as  the  feet  have  been  dried,  the  callosities 
and  excrescences  can  be  rubbed  off  with  a  coarse  towel.     Then  the; 

341 


342  THE    HUMAN    FOOT 

feet  should  be  thoroughly  massaged,  using  the  healing,  penetrating 
pedico  foot  balm.  If  the  skin  is  naturally  soft  and  moist,  an  astring- 
ent solution  should  be  used.  When  the  skin  on  the  Plantar  surface 
is  hard  and  chapped,  it  must  be  rubbed  until  it  becomes  smooth,  after 
which  the  foot  is  massaged  with  soothing  balm.  If  the  fissures  ex- 
tend through  the  skin  after  the  thickening  has  been  removed,  their 
sides  should  be  kept  in  apposition  with  strips  of  adhesive  plaster 
drawn  tightly  over  the  Dorsal  side. 

The  perspiration  of  the  feet  rarely  if  ever  requires  medical  atten- 
tion, unless  it  is  so  excessive  as  to  be  a  source  of  annoyance,  or  the 
odor  so  disagreeable  as  to  be  offensive.  The  latter  causes  the  person 
affected  much  discomfort.  The  odor  in  warm  weather  or  hot  rooms 
is  most  perceptible,  and  in  many  cases  so  fetid  that  the  society  of  the 
person  affected  is  avoided. 

There  is  not  any  permanent  cure,  but  bathing  the  feet  in  antiseptic 
and  astringent  solutions,  with  frequent  change  of  stockings  in  which 
a  good  foot  powder  has  been  previously  sprinkled,  usually  ameliorates 
the  condition. 

Feet  that  are  cold  and  clammy  denote  debility,  and  only  temporary 
relief  can  be  expected  from  external  applications. 

The  feet,  like  the  face,  hands  and  hair,  should  be  carefully  attended 
to  each  day  as  a  matter  of  comfort  and  refinement.  They  should  be 
washed  well  with  pedico  granular  soap,  massaged  with  pedico  foot 
balm  and  then  antiseptic  powder  should  be  sprinkled  over  the  feet 
and  in  the  stockings.  Change  stockings  each  day  and  alternate  the 
wear  of  shoes. 


CHAPTER    XLIII 


METHOD    OF    MAKING    PLASTER    OF   PARIS 
CAST    OF    THE    FOOT 

The  making  of  a  good  plaster  of  paris  model  of  the  foot  is  not  a 
difficult  operation,  and  can  be  readily  learned  with  a  little  practice 
and  adherence  to  the  following  directions.     As  the  quantity  of  plaster 


Chart  No.  217 
After  Foot  Has  Been  Lubricated  It  is  Placed  in  Plaster. 

required  to  make  the  mixture  depends  on  atmospheric  conditions  and 
grades  of  plaster  used,  we  have  selected  for  convenience  the  standard 
plaster  known  as  "New  York  Dental  Grade,"  and  which  requires 
about  four  pounds  to  a  quart  of  water. 

343 


344 


THE    HUMAN    FOOT 


In  preparing  the  plaster  for  making  the  cast,  it  should  be  grad- 
ually added  to  the  water,  stirring  it  with  the  hands  or  a  spoon  until 
thoroughly  mixed  to  the  consistency  of  a  heavy  cream. 

When  taking  a  Plantar  or  sole  impression  of  the  foot,  procure  a 
shallow  box,  or  lid  of  a  shoe  carton,  large  enough  to  permit  the 
entrance  of  the  entire  foot;  previously  lined  with  a  towel  covered  with 
tissue  paper,  which  is  to  hold  the  plaster  of  paris. 

In  order  to  prevent  the  adherence  of  plaster  to  the  flesh,  cold 
cream  or  vaseline  should  be  applied  to  that  part  from  which  the  cast 


Chart  No.  218 
Heaping  Plaster  Under  the  Arch. 


is  to  be  made.  If  the  patient  has  a  heavy  growth  of  hair,  it  is  ad- 
visable to  shave  that  portion  coming  in  contact  with  the  cast. 

Now  that  all  is  in  readiness,  prepare  the  plaster  as  described  above 
and  pour  it  into  the  box,  heaping  it  up  well  under  the  arch,  being  care- 
ful that  it  is  of  the  proper  consistency;  otherwise  it  will  flow  over  the 
edge  of  the  container. 

The  patient  should  then  be  seated  in  a  comfortable  position,  with 
his  foot  resting  in  the  plaster  as  in  Chart  No.  217,  exerting  sufficient 
pressure  to  take  an  impression  of  the  heel  and  toes.  When  the  foot 
is  firmly  settled,  grasp  the  towel  and  paper  as  in  Chart  No.  218,  and 
draw  the  plaster  up  towards  the  instep  on  the  inner  side  of  the  foot. 


HOW    TO    MAKE    PLASTER    CASTS 


345 


Chart  No.  219 
Grasping   Towel    Containing   the    Plaster   and   Heaping   It   Against   Arch. 


Chart  No.  220 
After  Cast  of  Sole  Surface  is  Lubricated,  Plaster  Mixture  is  Poured  Into  It. 


346 


THE    HUMAN    FOOT 


Chart  No.  219  gives  you  another  view  of  the  same  operation,  show- 
ing' the  other  foot.  This  is  the  method  to  follow  for  taking  Plantar 
or  sole  impressions. 


Chart  No.  221 
breaking  Plaster  Cast  Away  from  Positive  or  Counter  Cast. 


IhHS 

Jfk.    ' 

"' 

A 

k.                   _^rfltf 

9 

1 
■i 

: 1 

Chart  No.  222 
Cast   Freed   from   Negative. 


When  the  plaster  of  paris  becomes  thoroughly  set  or  hard,  remove 
the  foot  by  carefully  lifting  out  the  heel  and  then  drawing  the  foot 
back  and  upward.  After  five  or  ten  minutes  this  cast  is  to  be  lubri- 
cated with  cold  cream,  oil  or  vaseline. 


HOW    TO    MAKE    PLASTER    CASTS  347 

The  lubricant  is  put  into  the  negative  cast  and  on  the  outer  edges 
around  the  impression  to  prevent  the  counter  or  positive  cast  from 
adhering. 

Another  batch  of  plaster  should  now  be  mixed  and  poured  into  the 
negative,  as  illustrated  in  Chart  No.  220,  permitting  it  to  work  its 
way  around  the  entire  cast,  thus  preventing  air-bells  or  bubbles. 
"When  the  plaster  becomes  heavier  add  a  sufficient  quantity  to  fill  the 
depression,  allowing  it  to  set  for  about  twenty  minutes,  when  the 
negative  may  be  broken  and  the  positive  removed. 

The  best  way  to  remove  the  positive  or  positive  cast  is  by  taking 
a  hammer  as  in  Chart  No.  221  and  breaking  first  the  outer  side,  then 
the  toe  part.  After  this  has  been  done  you  will  find  the  cast  is  now 
entirely  free  from  the  shell  or  negative  as  in  Chart  No.  222. 

To  Take  a  Plaster  Cast  of  the  Entire  Foot  Above  the  Ankle. 

The  previous  method  of  taking  a  Plantar  surface  impression  should 
be  followed,  but  the  foot  is  not  to  be  removed.  A  double  layer  of 
tissue  paper  is  evenly  placed  around  the  foot  over  the  sole  impres- 
sion, instead  of  oiling  to  prevent  the  adherence  of  the  other  wet 
plaster  added  above.  Now  obtain  a  strong  piece  of  white  cord,  which 
is  tied  around  the  leg  above  the  ankle,  as  in  Chart  No.  223,  one  end 
dropped  down  back  over  the  Tendo-Achillis  and  the  other  end  for- 
ward down  the  center  of  and  over  the  Dorsum  of  the  foot  to  the 
second  toe.  The  purpose  of  this  string  is  to  cut  the  upper  cast  be- 
fore it  is  entirely  set.  Now  mix  the  plaster  in  the  usual  manner, 
somewhat  thinner  than  before,  and  place  it  around  the  foot  with  your 
hands,  entirely  covering  it,  as  in  Chart  No.  224,  being  careful  that 
the  cord  closely  adheres  to  the  flesh,  and  that  the  plaster  is  smoothly 
applied. 

To  mix  the  first  batch,  a  pound  of  plaster  to  ten  ounces,  a  little 
over  a  half  pint,  of  water  is  sufficient.  Allow  this  to  set  for  a  few 
minutes ;  in  the  intervening  time  mix  another  batch  using  about  four 
pounds  of  plaster,  somewhat  thinner  than  usual  but  heavier  than  the 
previous  mixture. 


348 


THE    HUMAN    FOOT 


Chart  No.  223 
Cord  Tied  Around  Top  and  on  Front  and  Back  of  Foot  to  Separate  Cast. 


Chart  No.  224 
Placing  Plaster  Around  Foot  Over  the  Cord. 


HOW   TO    MAKE    PLASTER    CASTS  349 


Chart  No.  225 
Drawing  Ends  of  Cord  Through  the  Plaster. 


Chart  No.  226 
Showing   How   Flesh   is  Drawn  Away  from   Cast. 


350 


THE    HUMAN    FOOT 


Chart  Xo.  227 
Separating  the  Two  Halves. 


Chart  No.   228 
Casts  of  Sole  and  Two   Sides  Removed  from  Foot  Ready  for  Lubricating 


HOW    TO    MAKE    PLASTER    CASTS 


351 


Apply  this  over  the  now  forming  shell  until  a  firm  and  heavy  coat- 
ing is  obtained,  as  in  Chart  No.  224.  When  the  plaster  starts  to  set 
take  both  cords  in  your  hands  and  draw  them  up,  cutting  through 


Chart  No.  229 
Pouring  Plaster  in  Negative  After  Being  Tied  Together. 


the  plaster  as  you  would  cut  a  bar  of  soap.     Now  remove  the  cord, 

as  in  Chart  No.  225,  and  allow  the  plaster  to  set  until  it  becomes  hard. 

Do  not  remove  the  cord  before  the  plaster  starts  to  set,  as  it  will 

wash  together;  also  do  not  let  it  set  too  hard,  as  you  will  be  unable 


352 


THE    HUMAN    FOOT 


to  remove  it,  and  consequently  will  have  to  break  the  shell  in  order 
to  remove  it  from  the  foot. 

To  free  the   hair  from  the  cast  before  it  becomes   entirely  hard, 
grasp  the  leg"  as  in  Chart  No.  226  and  draw  the  flesh  away  from  the 


Chart  No.  230 
Pouring   Plaster   Back   Into   Bowl. 


cast.  Generally  it  requires  about  six  or  seven  minutes  for  the  plaster 
to  set,  but  this  varies  according  to  climatic  conditions  and  to  the 
nature  of  your  preparation. 


HOW    TO    MAKE    PLASTER    CASTS 


353 


It  can  be  seen  in  Chart  Xo.  227  how  two  halves  can  be  readily 
freed  by  gently  prying  in  the  front  and  back  with  a  screwdriver. 

Chart  Xo.  228  shows  three  parts  of  the  cast  all  ready  for  lubri- 
cating, which  may  be  plastered  or  tied  together  with  cord. 

As  you  now  have  a  complete  negative  cast  of  the  foot,  and  are 
ready  for  the  positive  or  counter  cast,  prepare  your  mixture,  which 
is  to  have  the  consistency  of  cream ;  then  place  your  cast  at  an  angle, 


IIt^T 

^^Bi 

ilk-Jfe^Hiri 

pftr 

's 

■MB 

WMfcr\ 

W? 

..-    .  ^ 

A 

■w.^aw 

-^  -  T^, 

Chart  No.  231 
Shell   is   Broken   and   Cast  is   Removed. 


as  in  Chart  Xo.  229,  in  order  that  the  plaster  will  flow  evenly  into  all 
points  of  the  cast.  You  then  fill  the  cast  about  half  full,  rotating  it 
to  wash  the  plaster,  avoiding  air-bells  or  bubbles ;  it  is  then  poured 
back  into  the  bowl  as  in  Chart  Xo.  230 

This  operation  should  be  repeated  two  or  three  times  until  an 
inner  coat,  three-fourths  to  an  inch  in  thickness,  is  formed  on  the 
entire  inner  side  of  the  shell  or  negative,  and  in  which  time  will 
become  quite  hard  and  unable  to  run. 

23 


354 


THE    HUMAN    FOOT 


By  following  these  directions  a  firm,  strong-  cast,  light  in  weight, 
can  be  made.  It  requires  about  thirty-six  hours  to  thoroughly  dry 
out. 


Chart  No.  232 
Finished  Cast  and  Original  Foot. 


If  a  solid   cast   is   desired   the   same   method   should  be  pursued, 
finally  filling  the  entire  shell. 


HOW   TO   MAKE   PLASTER   CASTS 


355 


This  is  set  aside  for  twenty  minutes  to  a  half  hour  and  the  shell 
then  broken  and  removed  as  shown  in  Chart  No.  231. 


Chart  No.  233 
Plaster  is  Poured  into  Towel  or  Paper  Placed  in  Palm  of  Hand. 


Chart  No.  234 
Placed  About  Part  to  be  TaKen. 


If  these  directions  are  adhered  to  and  the  work  carefully  performed, 
the  completed  cast  will  be  a  perfect  reproduction  of  the  patient's  foot, 
showing  in  detail  every  line  of  demarkation  and  deformities  as  found 
in  the  natural  foot.     (See  Chart  No.  232.) 


356 


THE    HUMAN    FOOT 


Chart  No.  235 
Removing  Hand,  Towel  or  Paper. 


Chart  No.  236 
Negative  Removed  Ready  for  Counter  Cast 


HOW  TO   MAKE    PLASTER   CASTS 


357 


Method  of  Taking  Cast  of  Bunion  or  Enlarged  Toe  Joint. 

The  surface  of  the  foot  about  the  bunion  is  lubricated  as  previously 
described.  Having  the  mixture  prepared,  a  double  layer  of  towels  or 
newspapers  is  placed  in  the  palm  of  the  hand  as  in  Chart  Xo.  233, 


Chart  No.  237 
Removing  the  Cast  from  Negative  Showing  Exact  Reproduction  of  Enlarged  Toe  Joint. 


then  placed  directly  over  and  around  the  part  from  which  the  cast  is 
to  be  taken.     (See  Chart  Xo.  234.) 

Allow  to  set  for  about  eight  to  ten  minutes,  when  the  towel 
should  be  removed  as  in  Chart  Xo.  235,  then  gently  loosen  and 
remove  the  negative  from  the  foot.      (See  Chart  Xo.  236.)      Permit 


358  THE    HUMAN    FOOT 

this  to  set  for  thirty  minutes,  lubricate  inside  and  around  the  top 
edge,  then  prepare  the  mixture  and  pour  it  into  the  negative  cast, 
allowing  it  to  set  for  fifteen  minutes  when  it  may  be  removed.  (See 
Chart  No.  237.) 

These  casts  are  necessary  and  convenient  when  a  special  bunion 
reducer  is  to  be  fitted ;  also  when  the  reducer  or  shield  is  to  be 
made  to  the  order  of  the  patient. 


Index  to  Illustrations 


Anatomy,    Comparative 

Chart  Xo.  33 92 

Ankle,  Weak 

Chart  Xo.   149 212 

"     150 213 

Arch,  Broken-down 

Chart  Xo.  53 125 


54 
55 
56 
57 
58 
59 
60 
61 
62 
63 
64 
65 
66 
67 
68 


126 

128 
129 
130 
131 
132 
133 
133 
134 
135 
137 
138 
138 
139 
141 


Arch  Supports,  Method  of  Fitting 


Chart  Xo.  100 
101 
102 
103 
104 
105 
106 
107 
108 
109 


168 
169 
169 
170 
170 
171 
172 
173 
174 
175 


Chart  Xo.  110 

«  m 


"  112  ..  .. 

-  "    "  113  .... 

"  114.... 

"  115  .... 

"  116.... 

"  117  .... 

"  118  .... 

"  119  .... 

"  120  . . . . 

"  121  .... 

Arches  of  the  Foot 

Chart  Xo.   4  .... 

"   5  .... 

6  .... 

"  A6  .... 

Arteries  of  the  Foot 

Chart  Xo.      21    .  . . 

22   .  . . 


"     A23   

23   

24  

Bandaging  and  Strapping 

Chart  Xo.  80 

"     81 

"    82 

Bones  of  the  Leg  and  Foot 
Chart  Xo.  Al   

1  

2  

A3 

3  

7 


176 
177 
178 
179 
180 
181 
182 
183 
183 
184 
185 
186 

25 
26 
27 
28 

67 
69 
71 
74 

75 

150 
151 
152 

11 
13 
14 
15 
16 
23 


359 


360 


THE    HUMAN    FOOT 


Bow-Legs 

Chart  No.  160 229 

"     161 230 

"     162 232 

Bunion,  Hallux  Valgus  and 

Chart  No.  122 188 

"     123 189 

"     124 190 

"     125 191 

"     126 192 

"     127 193 

"     128 194 

"     129 195 

"       ' "     130 196 

"     131 196 

Bunion,  Treatment  of 

Chart  No.  138 200 

Callosities 

Chart  No.  178 285 

"  179 286 

"  180 286 

"  181 287 

"  182 287 

"  183 288 

"  184 288 

Callous 

Chart  No.  178 285 

"  179 286 

"  180 286 

"  181 287 

"  182 287 

"  183 288 

"  184 288 

Casts,  Plaster,  Method  of  Making 

Chart  No.  217 343 

"  218 344 

"  219 345 

"  220 345 

"  221 346 

"  222 346 


lart  No.  223 

348 

"  224 

348 

"  225 

349 

"  226 

349 

"  227 

350 

"  228 

350 

"  229 

351 

"  230 352 

"  231 353 

"  232 354 

"  233 355 

"  234 355 

"  235 356 

"  236 356 

"  237 357 

Club-Foot 

Chart  No.  151 215 

"  152 217 

"  153 220 

"  154 221 

Comparative  Anatomy 
Chart  No.  33 92 

Consideration  of  the  Foot, 
Mechanical 

Chart  No.  37 102 

"  38 103 

"  39 105 

Corns  (Cornu,  Horn) 

Chart  No.  167 275 

"  168 275 

"  169 276 

"  170 276 

"  171 277 

"  172 277 

"  173 278 

"  174 278 

"  175 279 

"  176 280 

"  177 281 


INDEX    TO    ILLUSTRATIONS 


361 


Examining,  Method  of 

Chart  No.  40 109 

"     41 ' 110 

"     42 Ill 

"    43 112 

"     44 113 

"     45 114 

"    48 118 

"    93 162 

Feet,  Fractures  Affecting  the 

Chart  No.  165 259 

"     166 260 

Felt  Padding 

Chart  No.  132 197 

"     133 197 

"     134 198 

"     135 198 

"     136 199 

"     137 199 

Fitting  Arch  Supports, 

Method  of 

Chart  No.  100 168 

"     101 169 

"     102 169 

"     103 170 

"    104 : . .  170 

"     105 171 

"     106 172 

"     107 173 

"     108 174 

"     109 175 

"     110 176 

"     111 177 

"     112 178 

"     113 179 

"     114 180 

"     115 181 

"     116 182 

"     117 183 

"     118 183 


Chart  No.  119 184 

"     120 185 

"     121 186 

Fitting  of  Shoes,  Footwear  and 

Chart  No.  207 329 

"     208 330 

"    209 330 

"     210 330 

Fitting  Ready-to-Wear  Shoes 

Chart  No.  201 324 


202 
203 
204 
205 
206 
207 
208 
209 
210 


324 
325 
325 
326 
328 
329 
330 
330 
330 


Fiat-Foot — Broken-down  Arch 
Chart  No.  53 125 


54 
55 
56 
57 
58 
59 
60 
61 
62 
63 
64 
65 
66 
67 
68 


126 
128 
129 

130 
131 
132 
133 
133 
134 
135 
137 
138 
138 
139 
141 


Fiat-Foot,  Treatment  of 

Chart  No.  69 142 

"    70 143 

"    71 143 


362 


THE    HUMAN    FOOT 


Chart  No.  72 145 

"     73 146 

"     74 146 

"     75 146 

"     76 147 

"    77 147 

"    78 148 

"    79 149 

"    80 150 

"    81 151 

"    82 152 

Foot,  Arches  of  the 

Chart  No.      4  25 

5   26 

6  27 

"    A6  28 

Foot,   Arteries   of  the 

Chart  No.      21    67 

"22  69 

"     A23  71 

23   74 

"   .    24  75 

Foot,  Bones  of  the  Leg  and 

Chart  No.  Al    11 

1    13 

2   14 

"     A3   15 

"       3   16 

7   23 

Foot,  Club 

Chart  No.  151 215 

"     152 217 

"     153 220 

"     154 221 

Foot,  Flat 

Chart  No.  53 125 

"     54 126 

"    55 128 

"    56 129 


Chart  No.  57 130 

"     58 131 

"     59 132 

"     60 133 

"     61 133 

"     62 134 

"    63 135 

"    64 137 

"65 138 

"    66 138 

"    67 139 

"     68 141 

Foot,  Flat,  Treatment  of 

Chart  No.  69 142 

"     70 143 

"     71 143 

"     72 145 

"     73 146 

"     74 146 

"     75 146 

"     76 147 

"     77 147 

"     78 148 

"     79 149 

"    80 150 

"     81 151 

"     82 152 

Foot,  Ligaments  of  the 

Chart  No.        8   34 

9  36 

10  38 

11    39 

"    A12  41 

Foot,  Measuring,  Method  of 

Chart  No.  201 324 

"     202 324 

"    203 325 

"     204 325 

"     205 326 

"    206 328 


INDEX    TO    ILLUSTRATIONS 


363 


Foot,  Mechanical  Considera- 
tion of  the 

Chart  No.  37 102 

"     38 103 

"    39 105 

Foot,  Muscles  and  Tendons 
of  the 

Chart  No.  B16  55 

"     C16  57 

16  58 

17  60 

18  61 

19  63 

20  64 

Foot,  Nerves  of  the  Leg  and 

Chart  No.  27 82 

"     28 83 

"     29 84 

"     30 86 

Foot,  Veins  of  the  Leg  and 

Chart  No.  25 78 

"    26 79 

Foot,  Weak 

Chart  No.  46 115 

"    47 117 

"    48 118 

"    50 121 

"     52 123 

"     56 129 

Foot,  Weak,  Mechanical 
Correction  of 

Chart  No.  49 119 

"     51 122 

"    69 142 

"    79 149 

Footwear,  History  of 

Chart  No.  191 298 

"     192 300 

"     193 303 

"        "     194 306 


Chart 

No.  195 

308 

" 

"     196 

310 

a 

"     197 

311 

u 

"     198 

313 

a 

"     199 

314 

a 

"    200 

316 

Fractures  Affecting  the  Feet 

Chart 

No.  165 

259 

(< 

"     166 

260 

Hallux 

Rigidus  or  Painful 

Great  Toe 

Chart 

No.  139 

201 

Hallux 

Valgus  and  Bunion 

Chart 

No.  122 

188 

" 

"     123 

189 

" 

"     124 

190 

" 

"     125 

191 

(< 

"     126 

192 

a 

"     127 

193 

<< 

"     128 

194 

<( 

"     129 

195 

<< 

"     130 

196 

•< 

"     131 

196 

Hallux  Varus  or  Pigeon  Toe 

Chart 

No.  140  .. 

202 

Heel,  Painful 

Chart 

No.  141 

204 

a 

"     142 

205 

it 

"     143 

206 

Hosiery 

Chart 

No.  211 

334 

(< 

"    212 -... 

335 

<< 

"    213 

336 

« 

"     214  ..  .  .L_^^ 

337 

<< 

"    215 

o3"8- 

ct 

"    216 

339 

Knee,  Knock 

Chart 

No.  158 

227 

« 

"     159 

228 

364 


THE    HUMAN    FOOT 


Knee,  Tubercular 

Chart  No.  163 234 

Leg,  Muscles  and  Tendons  of  the 


Chart  No. 


12  

13   

14  

15   

"    A16  

Leg  and  Foot,  Bones  of  the 
Chart  No.  Al    11 


45 
47 
48 
50 
53 


1 
2 
A3 
3 
7 


13 
14 
15 
16 
23 


Leg  and  Foot,  Nerves  of  the 

Chart  No.  27 82 

"28 83 

"29 84 

"    30 86 

Leg  and  Foot,  Veins  of  the 

Chart  No.  25 78 

"     26 79 

Ligaments  of  the  Foot 

Chart  No.        8  34 

9  36 

10  38 

11   39 

"     A12  41 

Mechanical  Consideration  of 
the  Foot 

Chart  No.  37 102 

"     38 103 

"    39 105 

Metatarsalgia — Morton's  Toe 

Chart  No.  83 153 

"    84 154 

"     85 155 

"    86 156 


Chart  No.  87 157 

"     88 158 


89 
90 
91 
92 
93 


159 
160 
160 
161 
162 


Metatarsalgia,  Treatment  of 
Chart  No.  94 163 


95 
96 
97 
98 
99 


163 
164 
165 
165 
166 


Morton's  Toe 
Chart  No.  83 153 


84 
85 
86 
87 
88 
89 
90 
91 
92 
93 


154 
155 
156 
157 
158 
159 
160 
160 
161 
162 


Morton's  Toe,  Treatment  of 
Chart  No.  94 163 


95 
96 
97 
98 
99 


Muscles  and  Tendons  of  the 
Foot 

Chart  No.  B16   

"     C16  

16  

17  

18  


163 
164 
165 
165 
166 


f-5 
57 
58 
60 
61 


INDEX    TO    ILLUSTRATIONS 


365 


Chart  No.      19   63 

20  64 

Muscles  and  Tendons  of  the  Leg 

Chart  No.      12   45 

13   47 

14 48 

15   50 

"    A16 53 

Nail,  Ingrowing  Toe 

Chart  No.  185 289 

"     186 290 

Nails,  The  Skin  and 

Chart  No.  31 89 

Nerves  of  the  Leg  and  Foot 

Chart  No.  27 82 

"    28 83 

"    29 84 

"    30 86 

Padding,  Felt 

Chart  No.  132 197 


133 
134 
135 
136 
137 


197 
198 
198 
199 
199 


Pes  Cavus  or  Contracted  Foot 

Chart  No.  155 224 

"     156 225 

Physiology 

Chart  No.  34 


35 
36 


99 
100 
101 


Pigeon  Toe 

Chart  No.  140 202 

Skiagraphy 

Chart  No.   187 293 

"     188 294 

"     189 295 

"     190 295 


Skin  and  Nails 

Chart  No.  31 89 

Strapping,  Bandaging  and 

Chart  No.  80 150 

"    81 151 

"    82 152 

Supernumerary  Toes 

Chart  No.  164 246 

Talipes  or  Club-Foot 

Chart  No.  151 215 

"     152 217 

"     153 220 

"     154 221 

Tendons  of  the  Foot, 
Muscles  and 

Chart  No.  B16   55 

"     C16  57 

16  58 

17  60 

18  61 

19 63 

"       20  64 

Tendons  of  the  Leg, 
Muscles  and 
Chart  No.      12   45 

13   47 

14  48 

15   50 

"     A16 53 

Toe,  Great,  Painful 

Chart  No.  139 201 

Toe,  Hammer 

Chart  No.  144 208 

"     145 209 

"     146 209 

"     147 210 

"     148 211 

Toe,  Morton's 

Chart  No.  83 153 

"    84 154 


366 


THE    HUMAN    FOOT 


Chart  No.  85 155 


"    86 

156 

"    87 

157 

"    88 

158 

"    89 

159 

"    90 

160 

"    91 

160 

"    92 

161 

"    93 

162 

Toe,  Morton's,  Treatment  of 

Chart  No.  94 

163 

"    95 

163 

"    96 

164 

"    97 

165 

"    98 

165 

"    99 

166 

Toe-Nail,  Ingrowing 

Chart  No.  185 

289 

".   186  

290 

Toe,  Pigeon 

Chart  No.  140 

707 

Toes,  Supernumerary 

Chart  No.  164 

246 

Veins  of  the  Leg  and  Foot 

Chart  No.  25 

7f^ 

"    26 

79 

Walking 

Chart  No.  37 

107 

"    39 

105 

Weak  Foot 

Chart  No.  46 

115 

"    47 

117 

"    48 

118 

"     50 

121 

"    52 

173 

"    56 

179 

Weak  Foot,  Mechanical 

Correction  of 

Chart  No.  49 

119 

"     51 

177 

"    69 

147 

"        «    79 

149 

Index  to  Subjects 


A 

Abduction   of  the   foot 98 

Fractures   by  eversion   and 259 

Abductor   Minimi    Digiti    59 

pollicis    58 

Abductors    63 

Accessorius,   Flexor    59 

Accidents  to  the  Patella  and  its  ligaments 233 

Achillis,  Tendo   49 

Achillotenontitis    205 

Acuminata,  Verruca 245 

Acuminatum,    Condyloma    245 

Adduction   of   the   foot 98 

Adductor  pollicis    62 

Adductors    64 

Adjustment,  How  to  make  secondary 185 

Affections,  Joint,  simulating  rheumatism 237 

Anatomy,   comparative    91 

Ancients,  Footwear  of  the 297 

Anglo-Norman  footwear  304 

-Saxon  footwear    302 

Anhidrosis,  or  scanty  perspiration 249 

Ankle,  Dislocations  at  or  near  the 266 

joint,  Ligaments   of  the 35 

Sprained    213 

Tuberculosis  of  the 214 

Weak   212 

Ankles,  weak,  and  inward  rotation,  Fitting  for 182 

weak,   Children's,   Fitting  for 185 

Ankylosis    244 

of  the  patella  234 

Annular  ligament,  Anterior   54 

External    55 

Internal    54 

367 


368  THE    HUMAN    FOOT 

Anterior  fasciculus  36 

group  of  extensor  muscles  of  the  leg 44 

inferior   tibio-fibular    ligament    34 

ligament    35 

peroneal  branch  of  the  posterior  tibial  artery 73 

tibial  artery   66 

tibial  nerve    86 

tibio-tarsal    ligament    35 

Anticus,  Tibialis 44 

Appendages    of   the    skin 89 

Arch,  Broken-down    125 

Extreme  high  and  contracted,  Fitting  for 182 

Inner   longitudinal    25 

Outer  longitudinal    26 

supports,  Method  of  fitting 168 

Transverse,  or  anterior 26 

Weak,  with  enlargement  at  first  metatarsophalangeal  joint, 

Fitting  for    182 

Weakened  transverse   153 

Arteries    31 

of  the  foot    66 

Anterior  tibial   66 

External  malleolar  branch   68 

Internal  malleolar  branch    68 

Muscular  branches  68 

Recurrent  tibial  branch    68 

Dorsalis  pedis    70 

Communicating  branch   72 

Dorsalis  pollicis    72 

Interosseous  branches   70 

Metatarsal  branch    70 

Tarsal  branch    70 

External  plantar    74 

Anterior  perforating,  or  digital  branches 76 

Posterior  perforating  branches   75 

Internal  plantar 74 

Popliteal  artery 66 

Posterior  tibial 72 

Communicating  branch   73 

Internal  calcanean    73 


INDEX  369 

Posterior  tibial  artery — Continued. 

Muscular  branches 73 

Nutrient  branch    . . 73 

Peroneal  artery  73 

Anterior  artery    73 

Articular  branches  of  internal  popliteal  nerve 81 

Astragalo-calcaneoid  joint,   Dislocation   of 269 

-scaphoid  joint,  Dislocation  of 269 

Astragalus 18 

dislocation  of  the,  Total 271 

Fracture  of  the   261 

B 

Ball  of  foot,  callouses  on,  Fitting  for. 184 

Bandaging  and  strapping  150 

Bent  bone % 254 

Blister    252 

Bone,  Astragalus 18 

Bent    254 

Cuboid    19 

Fibula 24 

Os   Calcis    18 

Scaphoid    19 

Tibia 22 

Bones,  The   11 

Cuneiform   19 

human   body,   of  the 12 

Metatarsal 21 

Metatarsus,  The   21 

Phalanges    22 

Tarsus,  The   18 

Bow-legs    • 229 

Boys'  shoes,  sizes  and  measurements 320,  323 

Brevis  digitorum,  Extensor   56 

Flexor   58 

minimi  digiti,  Flexor  62 

Peroneus    52 

pollicis,   Flexor    61 

Broken-down  arch    125 

Bromidrosis,  or  fetid  perspiration 249 


370  THE    HUMAN    FOOT 

Bunion,  Hallux  valgus  and 188 

Taking  plaster  cast  of 357 

Treatment  of   200 

Bursitis  about  the  knee 232 

Fitting  for    184 

Prepatellar,  or  housemaid's  knee 232 

Pretibial    233 

Pretubercular   233 


Calcanean  branch  of  the  posterior  tibial  artery,  internal 73 

Calcaneo-Astragaloid  ligament,  external 37 

posterior    37 

-Cuboid  ligament,  internal   39 

long   39 

short 40 

superior    38 

-Scaphoid  ligament,   inferior    40 

superior    40 

Calcaneum,  Dislocations  of  the 272 

fracture  of  the 261 

Calcaneus,  Talipes 223 

Callous  285 

Callouses  on  ball  of  foot,  Fitting  for 184 

Callosities    285 

Care  of  the  Feet 341 

Case  of  Metatarsalgia,  Typical 167 

Casts,  plaster,  Method  of  making 343 

of  plantar  impression 344 

of  entire  foot 347 

of  bunion  or  enlarged  toe  joint 357 

Cavus,  Pes   224 

Chilblains    247 

Children's  shoes,  sizes  and  measurements 322 

weak  ankles,   Fitting  for 185 

Claw-Foot,   Hollow    226 

Club-Foot    215 

Non-deforming 222 


INDEX  371 

Communicating  branch  of  dorsalis  pedis  artery 72 

of  posterior  tibial  artery 73 

Comparative  Anatomy    94 

Complete  Fractures   , 255 

Compound    Fracture    257 

Condyloma  Acuminatum    245 

Congelation    248 

Congenital  deformities  of  the  knee „ 230 

flat-foot    139 

hyperextension  of  the  knee 230 

Consideration  of  the  foot,  Mechanical 102 

Contracted  arch,  extreme  high  and,  Fitting  for 182 

foot  222 

Convalescent  patients    138 

Corns    274 

Hard    274,  275 

Nervo- Vascular 274,  283 

Soft    274,  281 

Suppurated 274,  282 

Vascular  274,  284 

Cramped  toes,  Fitting  for 185 

Crystallization  of  metals  from  which  arch  supports  are  made. . .  .    186 

Cuboid    bone    19 

Dislocations  of 272 

Cuneiform  bones 19 

External    20 

Internal    19 

Middle    20 

Dislocations    of  the 272 

Cutaneous  branch  of  the  internal  popliteal  nerve 81 

Cuticle    88 

D 

Deep  or  muscular  branch  of  the  external  plantar  nerve 85 

transverse  fascia   49 

Deformities,  Acquired   231 

Congenital 230 

of  the  knee  230 

acquired   deformities    231 

bursitis  about  the  knee 232 


372  THE    HUMAN    FOOT 

Deformities — Continued. 

bursitis,   prepatellar,   housemaid's   knee 232 

pretibial   233 

pretubercular    233 

congenital    deformities    230 

congenital  hyperextension  of  the  knee 230 

Deltoid    Ligament    35 

Depressions    254 

Derma 88 

Digital   branches  of  the   external   plantar  artery 76 

Digiti,   Abductor  minimi    59 

Flexor  brevis   minimi    62 

Digitorum,   Extensor  brevis    56 

Extensor  longus    44 

Flexor  brevis   58 

Flexor  longus    51 

Disease,   Raynaud's    242 

Diseases  affecting  the  feet 240 

Ankylosis    244 

Infantile  paralysis    240 

Myasthenia    (Intermittent   limping )    .  . 241 

Raynaud's    Disease    242 

Rickets    243 

Syphilis    241 

Varicose  Veins    243 

of  the  feet  245 

Anhidrosis  or  scanty  perspiration 249 

Blister    252 

Bromidrosis  or  fetid  perspiration 249 

Chilblains    (pernio)    247 

Eczema    250 

Frost  bite   248 

Hyperidrosis  or  excessive  perspiration 248 

Osteoma    251 

Perforating  ulcer  of  the  foot 247 

Plantar  neuralgia 251 

Supernumerary  toes   (polydactylism)    246 

Syphilis    250 

Verruca   or   wart    245 

Webbed   finsrers   and   toes 246 


INDEX  373 

Dislocation  of  the  Astragalus,  Total 271 

Medio-Tarsal    271 

Dislocations  affecting  the  feet 264 

at  or  near  the  ankle 266 

of  the  astragalo-calcaneoid  and  astragalo-scaphoid  joints...  269 

backward    270 

forward    270 

inward  or  inward  and  backward 269 

of  the  Fibula   265 

backward 265 

forward 265 

of  the  lower  end    265 

of  the  upper  end    265 

upward    265 

of  the  foot  (Tibio-Tarsal ) 267 

backward 267 

compound  and  complicated   269 

forward    268 

inward    268 

outward   268 

of   the    Metatarsal    bones    from    the    Tarsus    and    from    one 

another    272 

Metatarso-phalangeal    272 

of  the  phalanges 2/3 

of  the  Tarsal  and  Metatarsal  bones 272 

Calcaneum    272 

Cuboid   272 

Cuneiform   bones    272 

Scaphoid    272 

of  the  Tibia,  of  the  lower  end  of  the,  forward 267 

of  the  Toes    272 

of  the  Great  Toe    272 

of  the  other   toes    273 

Sub-Astragaloid    269 

Displaced  metatarsals,  Fitting  for 184 

Dorsal  interossei  " 62 

ligaments  of  the  Tarsus ^7 

ligaments  (Tarso-Metatarsal;    40 

Dorsalis  pedis  artery  70 

pollicis    72 


374  THE    HUMAN    FOOT 

E 

Eczema 250 

Enlarged  toe  joint,  making  cast  of 357 

Epidermis    88 

Epiphysis,   Separation   of  the 256 

Separation  of  a  Splinter  of  an 255 

Equinus,  Talipes  .' 220 

Erythromelalgia    251 

Eversion  of  the  foot 98 

and  abduction  of  the  foot,  Fracture  by. . . 259 

Examination  of  the  foot Ill 

Examinations   108 

Excessive   perspiration    248 

weight  carrying 136 

Exercises  151 

Extension  of  the  foot .• 98 

Extensor  brevis  digitorum   56 

longus  digitorum 44 

muscles  of  the  leg 44 

Anterior  group 44 

Extensor  longus   digitorum    44 

Extensor  proprius  pollicis    44 

Peroneus  tertius    46 

Tibialis  anticus    44 

Fibular  group 52 

Peroneus  brevis 52 

Peroneus  longus    52 

Posterior  group  46 

Deep  layer    49 

Flexor  longus  digitorum  51 

Flexor  longus  pollicis 51 

Popliteus   51 

Tibialis  posticus 51 

Superficial  layer 46 

Gastrocnemius    46 

Plantaris    49 

Soleus    48 

Tendo-Achillis    . 49 

proprius   pollicis 44 

Extensors    65 


INDEX  375 

External   annular  ligament    55 

branch  of  the  Anterior  tibial  nerve 87 

branch  of  the  Musculo-Cutaneous  nerve 87 

calcaneo-astragaloid  ligament    37 

cuneiform  bone    20 

lateral  ligament   36 

Anterior    fasciculus    36 

Middle  fasciculus    36 

Posterior    fasciculus    36 

malleolar  branch  of  the  anterior  tibial  artery 68 

or  short  Saphenous  nerve 81 

or  short  Saphenous  vein 80 

peroneal  nerve   85 

plantar  artery    74 

plantar  nerve    85 

popliteal    nerve 85 

Extreme  flat-foot  with  swelling,  Fitting  for 182 

high  and  contracted  arch,  Fitting  for 182 

F 

Fascia,  Deep  transverse   49 

Plantar 55 

Central  portion    56 

Inner  portion 56 

Outer  portion    56 

Feet,  Care  of  the 341 

Diseases  affecting  the  240 

Diseases  of  the   245 

Dislocations   affecting  the    264 

Fractures  affecting  the   253 

Felt   padding    197 

Fetid   perspiration    249 

Fibula    24 

Dislocations  of  the  265 

Fracture  of  the   261 

Fracture  of  the  upper  end  of  Tibia  and 257 

Fibular  group  of  extensor  muscles  of  the  leg 52 

Fifteenth   century,   Shoes   of  the 305 

Filiformis,   Verruca •  245 

Fingers  and  Toes,  Webbed 246 


376  THE    HUMAN    FOOT 

Fitting  Arch  Supports,  Method  of 168 

for  bursitis    184 

callouses  on  ball  of  foot 184 

children's  weak  ankles    185 

cramped  toes    185 

displaced  metatarsals  184 

extreme  high  and  contracted  arch 182 

flat-foot,    extreme,    with    swelling 182 

flat-foot,  moderate    181 

flat-foot,  rigid,  with  adhesions   182 

foot  strain   185 

heel,  painful,  spur  of  Os  calcis,  etc 184 

Metatarsalgia   184 

Morton's  toe    184 

weak  ankles  and  inward  rotation 182 

weak  arch  Avith  enlargement  at  first  metatarso-phalangeal 

joint    182 

weak  flexible  foot  181 

weak  foot  with  tendency  of  rolling  outward 185 

of  shoes  318 

ready-to-wear  shoes,  Measuring  for 324 

Flat-foot 125 

Acquired    127 

causes    136 

Congenital    139 

Fitting  arch   supports   for.  . . 181 

Traumatic    140 

Treatment  of   142 

Flexion  of  the  foot 98 

Flexor  accessorius    59 

brevis  digitorum 58 

brevis   pollicis    61 

brevis  minimi  digiti   62 

longus  digitorum    51 

longus  pollicis    51 

Flexors    65 

Foot,  abduction  of  the 98 

Acute  weakened   124 

Adduction  of  the 98 

Arteries  of  the    66 


1  INDEX  377 

Foot — Continued. 

Bones  of  the 11 

Callouses  on  ball  of,  Fitting  for 184 

Cast  of,  plaster,  method  of  making 343,  347 

Claw,   Hollow    • 226 

Club 215 

Contracted    222 

Dislocations  of  the   (Tibio-Tarsal) 267 

Eversion  of  the 98 

Examination  of  the   Ill 

Extension  of  the  ; 98 

Flat    ..' 125 

Flexion  of  the   98 

Fractures  by  eversion  and  abduction  of 259 

Functions  of  the 97 

Gonorrheal  infection  of  the 238 

.  Hollow    224 

Hollow  claw    226 

Hump 226 

Inversion  of  the 98 

Measuring  the,  for  fitting  ready-to-wear  shoes 324 

Mechanical  consideration  of  the 102 

Movements  of  the   98 

Muscles  and  tendons  of  the 54 

Perforating  ulcer  of  the 247 

Soft  structures  of  the 29 

strain,  Fitting  for  185 

Ulcer,  perforating,  of  the 247 

Weakened 117 

Weak  flexible 121 

Footwear,  History  of    297 

of  the  ancients    297 

Anglo-Normans   304 

Anglo-Saxons    302 

fifteenth  century   • 305 

fourteenth  century 304 

Greeks  and  Romans    299 

seventeenth  century,  Stuart  period 307 

sixteenth  century,  Tudor  period 307 

thirteenth   century    304 


378  THE    HUMAN    FOOT 

Footwear  and  fitting  of  shoes 318 

Measurements  of  last   318 

Standard  shoe  last  measurements 319 

Measurements  and  lengths    322 

Fourteenth  century,  Shoes  of  the 304 

Frost    Bite    248 

Fractures  affecting  the  feet 253 

Articular,   Intra-articular  or    256 

Bent   bone 254 

by  eversion  and  abduction  of  the  foot 259 

Complete    255 

Compound    257 

Depressions    254 

First  aid   for    262 

"Green  stick" 254 

Incomplete  254 

Intra-articular  or  articular   256 

Longitudinal    255 

Multiple  , 257 

Oblique    258 

of  the  Astragalus   261 

of  the  Calcaneum   261 

of  the  Fibula   261 

of  the  lower  end  of  leg 258 

of  the  Metatarsal  bones   262 

of  the  Os  calcis    261 

of  the  Patella    257 

of  the  Phalanges   262 

of  the  Sustentaculum  tali    262 

of  the  upper  end  of  the  tibia  and  fibula 257 

Pott's 259 

Signs  of 262 

Spiral    255 

Splintered    255 

Transverse    : 255 

Varieties  depending  upon  the  seat  of 256 

Functions  of  the  foot 97 

G 

Gastrocnemius 46 

General   review    90 


INDEX  379 

Genu  valgum , . , 227 

varum „ 229 

Glands,  Sebaceous    89 

Sudoriferous   89 

Sweat   89 

Gonorrheal  infection  of  the  foot , 238 

rheumatism 139 

Gout   236 

Great  Sciatic  Nerve   , 81 

External  popliteal  or  peroneal  nerve 85 

Anterior  tibial  nerve 86 

External  or  tarsal  branch 87 

Internal  branch   87 

Musculo-Cutaneous   nerve    87 

External  branch    87 

Internal  branch   87 

Internal  Popliteal  nerve   81 

Articular  branches    81 

Cutaneous  branch 81 

External  or  short  Saphenous  nerve 81 

Muscular  branches   81 

Posterior  tibial  nerve 81 

External  plantar  nerve    85 

Deep  or  muscular  branch 85 

Superficial  branch 85 

Internal  plantar  nerve   84 

Great  toe,  Dislocations  of 272 

Painful   201 

Greeks,  Footwear  of  the    299 

"Green  stick"  fracture    254 

Growth,   Rapid    137 

H 

Hair    89 

Hallux  rigidus  or  painful  great  toe 201 

valgus  and  bunion   188 

varus  or  pigeon  toe   202 

Hammer  toe 208 

Hard  corns    274,  275 

Heavyweight  persons 137 


380  THE    HUMAN    FOOT 

Heel,  Painful 204 

Fitting  for    184 

High  contracted  arch,  extreme,  Fitting  for 182 

History  of  footwear   297 

Hollow  claw-foot 226 

Hollow-foot    224 

Hosiery    334 

Housemaid's  knee   232 

Human  body,  Bones  of  the 12 

Hump-foot 226 

Hyperextension  of  the  knee,  Congenital 230 

Hyperidrosis  or  excessive  perspiration 248 

I 

Ill-fitting,  improperly  made  shoes 136 

Impression,  plantar,  Making  plaster  cast  of 344 

Incomplete  fracture    254 

Infantile  paralysis 240 

Infants'  shoes,  sizes  and  measurements. . '. 322 

Infection  of  the  foot,  Gonorrheal 238 

Inferior  calcaneo-scaphoid  ligament 40 

tibio-fibular  ligaments   33 

Anterior  inferior  ,tibio-fibular  ligament 34 

Inferior  osseous  ligament  35 

Posterior  inferior   tibio-fibular  ligament 34 

Transverse  ligament    34 

Ingrowing  toe  nail   289 

In-knee 227 

Inner  longitudinal  arch 25 

Intermittent  limping    241 

Internal  annular  ligament    54 

branch  of  the  anterior  tibial  nerve   87 

branch  of  the  musculocutaneous  nerve    .• .  87 

calcaneal!  branch  of  the  posterior  tibial  artery 73 

calcaneo-cuboid  ligament 39 

cuneiform  bone    19 

lateral  ligament  35 

malleolar  branch  of  the  anterior  tibial  artery 68 

or  long  saphenous  vein  79 

plantar  artery   74 


INDEX  381 

Internal — Continued. 

plantar  nerve   84 

popliteal  nerve 81 

Interossei,  Dorsal   62 

Plantar 62 

Interosseous  branches  of  the  dorsalis  pedis  artery 70 

Interosseous    ligaments 38,     41 

Intra-articular  or   articular  fracture 256 

Inversion  of  the  foot 98 

Inward   rotation,  weak  ankles  and,   Fitting  for 182 

J 

Joint   affections   simulating   rheumatism 237 

ankle,  Ligaments  of  the 35 

enlarged  toe,  Making  plaster  cast  of 357 

K 

Keratosis  Pigmentosa   245 

Knee,  Bursitis  about  the   '...." 232 

Deformities  of  the 230 

Acquired  deformities 231 

Bursitis  about  the  knee 232 

Congenital   deformities    ■ 230 

Congenital  hyperextension  of  the  knee 230 

Prepatellar  bursitis  or  housemaid's  knee 232 

Pretibial  bursitis 233 

Pretubercular  bursitis   233 

Housemaid's  232 

Knock 227 

Knock-knee    227 

with  weak  foot 229 

L 

Ladies'  shoes,  sizes  and  measurements 319,  323 

Last,  measurements  of 318 

measurements,  Standard  shoe 319 

Leg,  Extensor  muscles  of  the 44 

Fracture  of  the  lower  end  of  the 258 

Muscles  and  tendons  of  the 43 

Nerves  of  the 81 


382  THE    HUMAN    FOOT 

Leg — Continued. 

Veins  of  the  77 

Lengths,  Measurements  and   : 322 

Ligaments    29,  33 

Annular,  Anterior    54 

External    55 

Internal    54 

Metatarsophalangeal  41 

Lateral  ligaments 42 

Plantar  ligaments    41 

of  the  ankle  joint 35 

Anterior,  or  anterior  tibio-fibular  ligament 35 

External  lateral  ligament  36 

Anterior  fasciculus  36 

Middle  fasciculus  36 

Posterior  fasciculus    36 

Internal  lateral,  or  deltoid  ligament 35 

Deep  layer   35 

.  Superficial   layer    35 

Posterior,  or  posterior  tibio-fibular  ligament 35 

of  the  tarsus 37 

Calcaneo-astragaloid  ligament,  External    37 

Posterior   37 

Calcaneo-cuboid  ligament,  Internal   39 

Long    39 

Short 40 

Superior    38 

Calcaneo-scaphoid  ligament,  Inferior 40 

Superior 40 

Dorsal  ligaments 37 

Interosseous  ligaments 38 

Plantar  ligaments   38 

Tarso-metatarsal   40 

Dorsal  ligaments 40 

Interosseous  ligaments    41 

Plantar  ligaments   41 

Tibio-fibular  ligaments    33 

Inferior  tibio-fibular  ligaments   33 

Anterior    34 

Posterior   34 


INDEX  383 

Tibiofibular — Continued. 

Inferior  osseous  ligament  35 

Transverse  ligament 34 

Middle    33 

Superior  or  upper    33 

Limb,  Short   138 

Limping,  Intermittent   241 

Locomotor  Ataxia    138 

Longitudinal  arch,  Inner    25 

Outer 26 

fracture  255 

Long  standing 136 

Lumbricales  59 

M 

Malleolar  branch  of  the  anterior  tibial  artery,  External 68 

Internal    68 

Measurements  of  last 318 

Standard  shoe  last 319 

Measuring  foot  for  fitting  ready-to-wear  shoes 324 

Mechanical  consideration  of  the  foot 102 

Medio-tarsal  dislocation    271 

Men's  shoes,  sizes  and  measurements 319,  323 

Metals  from  which  arch  supports  are  made,  Crystallization  of. .  .  186 
Metatarsal  bone,  Subluxation  of  the  head  of  a 272 

bones    21 

Dislocation  of  the  tarsal  and    272 

Dislocation  of  the,  from  the  tarsus  and  from  one  another. 272 

Fractures  of  the   262 

Metatarsal  branch  of  the  dorsalis  pedis  artery 70 

Metatarsalgia   153 

Fitting  arch  supports  for ,. 184 

Typical  case  of 167 

Metatarso-phalangeal  dislocations    272 

ligaments    41 

Metatarsus  and  phalanges   21 

Method  of  fitting  arch  supports '. 168 

Middle  cuneiform  bone   20 

Minimi  digiti,  Abductor   •  •     59 

Flexor  brevis 62 


384  THE   HUMAN    FOOT 

Misses'  shoes,  sizes  and  measurements 320,  323 

Morton's  toe 153 

Fitting  arch  supports  for 184 

Movements  of  the  foot 98 

Abduction  of  the  foot .  98 

Adduction  of  the  foot 98 

Eversion  of  the  foot 98 

Extension  of  the  foot. 98 

Flexion  of  the  foot ■. 98 

Inversion  of  the  foot ■ 98 

Multiple  fracture 257 

Muscles    30 

and  tendons  of  the  foot 54 

Dorsal    region    56 

Extensor  brevis  digitorum   56 

Plantar  region    57 

First  layer    57 

Abductor  minimi  digiti   59 

pollicis    58 

Flexor  brevis  digitorum 58 

Second  layer 59 

Flexor  accessorius    59 

Lumbricales    59 

Third  layer 60 

Adductor   pollicis    62 

Flexor  brevis  minimi  digiti 62 

pollicis    61 

Transversus   pedis    62 

Fourth  layer   62 

Abductors ' 63 

Adductors    64 

Dorsal  interossei   62 

Extensors    65 

Flexors    65 

Plantar  interossei    62 

and  tendons  of  the  leg 43 

Extensor  muscles  of  the  leg 44 

Anterior  group    44 

Extensor  longus  digitorum    44 

proprius   pollicis    •. 44 


INDEX  385 

Muscles^-Continued. 

Peroneus  tertius   46 

Tibialis  anticus    44 

Fibular  group    52 

Peroneus   brevis    52 

longus    52 

Posterior  group  46 

Deep  layer   49 

Flexor  longus  digitorum  51 

pollicis    51 

Popliteus   51 

Tibialis  posticus    51 

Superficial  layer    46 

Gastrocnemius   46 

Plantaris    49 

Soleus 48 

Muscular  branch,  Deep  or,  of  external  plantar  nerve 85 

branches  of  the  anterior  tibial  artery. 68 

internal   popliteal   nerve    81 

posterior  tibial  artery 73 

Musculocutaneous  nerve   87 

External  branch    87 

Internal  branch   87 

Myasthenia  (intermittent  limping)    241 

N 

Nail,  Ingrowing  toe  289 

Nails    90 

Skin  and   88 

Nerve,  Great  sciatic  81 

Anterior  tibial   86 

Musculocutaneous    87 

Plantar,  External   85 

Internal    84 

Popliteal,   External,   or  peroneal 85 

Internal    81 

Saphenous,  Short 81 

Tibial,  Posterior   • 81 

Nerves 32 

of  the  leg  and  foot 81 


386  THE   HUMAN    FOOT 

Nervo- vascular  corns   274,  283 

Neuralgia,  Plantar 251 

Nutrient  branch  of  the  posterior  tibial  artery 73 

Non-deforming  club-foot 222 

o 

Oblique  fracture   258 

Onychauxis 291 

Onychia 291 

Syphilitic 291 

Os  calcis 18 

Dislocations  of  the  272 

Fractures  of  the   261 

Osseous  ligament,  Inferior 35 

Osteoma    251 

Osteophytes  of  the  Os  calcis 205 

Outer  longitudinal  arch    26 

Overlapping  toes 211 

P 

Padding,   Felt    197 

Pain    115 

Painful  great  toe 201 

heel  204 

Fitting  arch  supports  for 184 

Palpation  112 

Papulosquamous  Syphilide 250 

Paralysis,  Infantile .  240 

Patella  and  its  ligaments,  Accidents  to  the 233 

Ankylosis  of  the  234 

Fracture  of  the  257 

Slipping  233 

Tuberculosis  of  the   233 

Pedis,  Dorsalis,  artery 70 

Transversus  62 

Perforating  branch  of  external  plantar  artery,  Anterior 76 

Posterior   75 

ulcer  of  the  foot 247 

Pernio    247 


INDEX  387 

Peroneal  artery  73 

Anterior j$ 

nerve,  external  85 

Peroneus  brevis 52 

longus 52 

tertius    46 

Perspiration,  Excessive  248 

Fetid 249 

Scanty 249 

Pes  cavus,  or  hollow-foot  224 

Phalanges 22 

Dislocations  of  the  273 

Fracture  of  the 262 

Metatarsus  and   21 

Physiology    97 

Pigeon  toe 202 

Pigmentosa,  Keratosis 245 

Plana,  Verruca 245 

Plantar  artery,  External  74 

Internal 74 

fascia    55 

impression,   Making  cast  of 344 

interossei  62 

ligaments    (metatarso-phalangeal)    41 

(tarsal) 38 

(tarso-metatarsal)   41 

nerve,  External   85 

Internal    84 

neuralgia    251 

Plantaris  49 

Plaster  of  paris  casts,  Method  of  making 343 

Bunion  or  enlarged  toe  joint 357 

Entire  foot   347 

Plantar  impression   344 

Pollicis,  Abductor 58 

Adductor 62 

Dorsalis 72 

Extensor   proprius    44 

Flexor   brevis    61 

longus •  •  •  •  51 


388  THE    HUMAN    FOOT 

Polydactylism 246 

Popliteal  artery 66 

nerve,   external    85 

internal    81 

Popliteus   muscle    51 

Posterior  calcaneo-astragaloid  ligament   37 

group  (muscles  of  the  leg) 46 

inferior  tibio-fibular  ligament   34 

ligament    35 

perforating  branches  of  the  external  plantar  artery. 75 

tibial  artery    72 

nerve    81 

tibio-tarsal    ligament    •  •  35 

Posticus,  Tibialis    51 

Pott's    fracture    259 

Prepatellar  bursitis,   or  housemaid's    knee 232 

Pretibial    bursitis    233 

Pretubercular   bursitis    233 

Proprius  pollicis,   Extensor    44 

R 

Rapid  growth 137 

Raynaud's   disease    242 

Recurrent  tibial  branch  of  anterior  tibial  artery 68 

Rheumatism    235 

Gonorrheal 139 

Joint  affections  simulating    237 

Rickets 139,  243 

Rigid  flat-foot  with  adhesions,   Fitting  for 182 

Rigidus,   Hallux    201 

Romans,  Footwear  of  the 299 

s 

Saphenous  nerve,  External  or  short 81 

Vein,  External  or  short 80 

Internal  or  long    79 

Scanty,  perspiration   249 

Scaphoid    bone 19 

Dislocations   of  the    272 


INDEX  389 

Sciatic  nerve,   Great    81 

Sebaceous,  glands  89 

Seborrhoeica,   Verruca    245 

Secondary  adjustment,  How  to  make 185 

Senilis,   Verruca    245 

Separation  of  the   epiphysis 256 

of  a  splinter  of  an  epiphysis 255 

Seventeenth  century,  Stuart  period,  Shoes  of 307 

Shoe  last  measurements,  Standard 319 

Shoes,   Fitting  of    ' 318 

History   of 297 

Short  calcaneo-cuboid  ligament    40 

limb 138 

Signs  of  fracture 262 

Sixteenth  century,  Tudor  period,  Shoes  of 307 

Sizes   and   measurements    322 

Skiagraphy    293 

Skin  and  Nails    88 

appendages  of  the 89 

Slipping   patella    233 

Soft   corns 274,  281 

structures  of  the  foot 29 

Soleus    48 

Spiral    fracture    255 

Splinter  of  an   epiphysis,   Separation  of  a 255 

Splintered    fracture 255 

Sprained  ankle 213 

Squamous  syphilide   250 

Standard  shoe  last  measurements 319 

Standing,  Long  136 

Strain,  foot.  Fitting  for 185 

Strapping,   Bandaging  and 150 

Structures  of  the  foot,  Soft 29 

Stuart  period,  seventeenth  century,  Shoes  of 307 

Sub-astragaloid   dislocations    • 269 

Subluxation  of  the  head  of  a  metatarsal  bone 272 

Sudoriferous  glands   . 89 

Superficial  branch  of  the  external  plantar  nerve 85 

Superior  calcaneo-cuboid   ligament    •  ■'  38 

scaphoid   ligament 40 


390  THE   HUMAN    FOOT 

Supernumerary   toes    246 

Suppurated   corns    274,  282 

Sustentaculum   tali,   Fracture   of 262 

Sweat  glands   89 

Signs  of  fracture    262 

Syphilitic  Onychia    291 

Syphilis    241,  250 

T 

Talalgia    205 

Talipes  or  club-foot 215 

calcaneus  223 

equinus    220 

valgus    222 

varus    222 

Tarsal  and  metatarsal  bones,  Dislocations  of  the 272 

branch  of  the  dorsalis  pedis  artery 70 

Tarso-metatarsal  ligaments    40 

Tarsus    18 

Ligaments  of  the   ^7 

Tendo-achillis    49 

Tendons    29 

of  the  foot,  Muscles  and    54 

of  the  leg,  Muscles  and   43 

Tertius,    Peroneus    46 

Thirteenth  century,  Shoes  worn  in  the 304 

Tibia 22 

Dislocation  of  the  lower  end  of  the,  forward 267 

and  fibula,  Fracture  of  the  upper  end  of 257 

Tibial  artery,  Anterior   66 

Posterior   72 

nerve,  Anterior    86 

Posterior    81 

Tibialis,   anticus 44 

posticus    51 

Tibio-fibular  ligaments    33 

Anterior    34 

Inferior    34 

Posterior    ' 34 


INDEX  391 

Tibio-tarsal   ligament,   Anterior    35 

Posterior    35 

Toe,  great,  Dislocations  of  the 272 

Painful  201 

Hammer    208 

joint,  enlarged,   Making  plaster  cast   of 357 

nail,  Ingrowing   '. 289 

Pigeon    202 

Toes,  Bones  of  the 22 

cramped,  Fitting  for    185 

Dislocations  of  the   272,  273 

Overlapping   .  . .  . 211 

Supernumerary    246 

Webbed 246 

Transverse  arch    26 

Weakened   153 

fascia,  Deep    49 

fracture    255 

ligament   34 

Transversus   pedis 62 

Traumatic  flat-foot  140 

Tuberculosis  of  the  ankle 214 

of  the  patella  233 

Tudor  period,  sixteenth  century,  Shoes  of 307 

u 

Ulcer,   Perforating,   of  the  foot 247 

Upper  end  of  tibia  and  fibula,  Fracture  of 257 

V 

Valgum,  Geru    227 

Valgus,  Hallux,  and  bunion 188 

Talipes    222 

Varicose  veins   243 

Varieties  depending  upon  seat  of  fracture 256 

Varum,  Genu  229 

Varus,  Hallux,  or  pigeon  toe 20- 

Talipes   222 

Vascular  corns   274,  284 


392  THE   HUMAN    FOOT 

Vein,  saphenous,  External  or  short 80 

Internal  or  long   79 

Veins 31 

of  the  leg  and  foot 77 

Varicose    243 

Venereal  wart   245 

Verruca  or  wart 245 

acuminata    245 

filiformis 245 

plana    245 

seborrhoeica    245 

senilis    245 

vulgaris    245 

w 

Wart   245 

Condyloma  acuminatum   245 

Keratosis   pigmentosa        245 

Venereal  wart    245 

Verruca  acuminata 245 

filiformis    245 

plana 245 

seborrhoeica    245 

senilis    245 

vulgaris    245 

Weak  ankle    212 

and  inward  rotation,  Fitting  for 182 

arch  with   enlargement  at  first   metatarso-phalangeal   joint, 

Fitting  for    182 

flexible  foot 121 

Fitting  for 181 

Weakened  foot    117 

Acute   : 124 

Fitting  for 185 

Webbed  fingers  and  toes 246 

Women's  shoes,  sizes  and  measurements 319,  323 

Y 

Youth's  shoes,  sizes  and  measurements 321,  323 


COLUMBIA  UNF 


ry  libraries 


This  book  is  due  on  th/T datc^ndicated  below,  or  at  the 
expiration  of  a  definite  yfriodJttter  the  date  of  borrowing,  as 
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DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

I             lltlSi      ^ 

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DEC1  °  1J 

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OCT  5     194< 

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